The rise in total ghrelin found to accompany some remaining cardiovascular risk markers and adiposity increase in patients with acromegaly remission after surgery could be interrelated, according to research published in The Journal of Clinical Endocrinology & Metabolism.
“Our prospective study found increases in weight and central adiposity after surgery for acromegaly along with reductions in many, but not all, markers of cardiovascular risk,” the researchers wrote. “Ghrelin levels rose in parallel with the less favorable anthropometric profile, novel evidence of a possible relationship of ghrelin to the increase in adiposity that follows surgical treatment of acromegaly mechanisms and long-term implications of changes with acromegaly treatment.”
At tertiary referral centers for pituitary tumors, Carlos Reyes-Vidal, MD, of the Columbia University College of Physicians and Surgeons, New York, and colleagues looked at 42 adults who had untreated active acromegaly before surgery.
The researchers evaluated changes in outcome measures from before to after surgery in 26 patients who achieved remission, or normal insulin-like growth factor I and 16 patients whose active acromegaly, or elevated IGF-I, persisted.
By 6 months, patients with remission had increases in total ghrelin, body weight, waist circumference, C-reactive protein, homocysteine, HDL and leptin, and decreases in systolic blood pressure, homeostasis model assessment, triglycerides and lipoprotein(a); the changes remained for 32 ± 4 months after surgery. Higher ghrelin correlated with the reduced levels of growth hormone, IGF-I and insulin and insulin resistance.
Patients with persistent active acromegaly did not demonstrate significant increases in weight, waist circumference and ghrelin. In 15 patients with remission, total body fat, trunk fat and percentage total body fat increased by 1 year after surgery: Increase in body fat correlated with increase in total ghrelin.
“It is unknown whether the changes represent a readjustment to the anthropometric and cardiovascular risk profile they would have were they not to have acromegaly,” the researchers wrote. “Further investigation into the mechanisms of these changes and their long-term implications is warranted.”
Disclosure: This work was supported by NIH and Columbia University Clinical and Translational Science Awards grants. On researchers was supported by the Doris Duke Foundation.