Journal Article

Glucose metabolism outcomes after pituitary surgery in patients with acromegaly

Venegas Moreno, Eva, Blanco, Concepción, de Miguel, Paz, Iglesias, Pedro, Irigaray Echarri, Ana, Ollero García-Agulló, María Dolores, Fajardo-Montañana, Carmen, Cordido, Fernando, Pascual-Corrales, Eider, Vicente Delgado, Almudena, Calatayud, María, González Molero, Inmaculada, Aulinas, Anna, Rodríguez Berrocal, Víctor, Novo-Rodríguez, Cristina, Tenorio-Jiménez, Carmen, Cámara, Rosa, Villar-Taibo, Rocío, Abellán Galiana, Pablo, Novoa-Testa, Iría, Recio-Córdova, José María, Paja, Miguel, Marazuela, Mónica, López Mezquita, Elena, Sampedro-Nuñez, Miguel, Bernabéu, Ignacio, Hanzu, Felicia Alexandra, Alvarez-Escola, Cristina, Lamas, Cristina, Percovich, Juan Carlos, Enseñat, Joaquim, Aznar, Silvia, Aviles-Pérez, María Dolores, Menéndez Torre, Edelmiro, Guerrero-Pérez, Fernando, Araujo-Castro, Marta, Moure Rodríguez, María Dolores, Asla, Queralt, González Fernández, Laura, Biagetti, Betina, García-Centeno, Rogelio, Gracia, Paola, Vidal-Ostos De Lara, Fernando, Puig-Domingo, Manel, Asensio-Wandosel, Diego, Benítez Valderrama, Pamela

2024

Overview

Aim To investigate the impact of pituitary surgery on glucose metabolism and to identify predictors of remission of diabetes after pituitary surgery in patients with acromegaly. Methods A national multicenter retrospective study of patients with acromegaly undergoing transsphenoidal surgery for the first time at 33 tertiary Spanish hospitals (ACRO-SPAIN study) was performed. Surgical remission of acromegaly was evaluated according to the 2000 and 2010 criteria. Results A total of 604 acromegaly patients were included in the study with a total median follow up of 91 months (interquartile range [IQR] 45–163). At the acromegaly diagnosis, 23.8% of the patients had diabetes mellitus (DM) with a median glycated hemoglobin (HbA1c) of 6.9% (IQR 6.4–7.9) [51.9 mmol/mol (IQR 46.4–62.8)]. In the multivariate analysis, older age (odds ratio [OR] 1.02, 95% CI 1.00-1.05), dyslipidemia (OR 5.25, 95% CI 2.81 to 9.79), arthropathy (OR 1.39, 95% CI 2.82 to 9.79), and higher IGF-I levels (OR 1.30, 95% CI 1.05 to 1.60) were associated with a greater prevalence of DM. At the last follow-up visit after surgery, 21.1% of the DM patients (56.7% of them with surgical remission of acromegaly) experienced diabetes remission. The cure rate of DM was more common in older patients (hazard ratio [HR] 1.77, 95% CI 1.31 to 2.43), when surgical cure was achieved (HR 2.10, 95% CI 1.01 to 4.37) and when anterior pituitary function was not affected after surgery (HR 3.38, 95% CI 1.17 to 9.75). Conclusion Glucose metabolism improved in patients with acromegaly after surgery and 21% of the diabetic patients experienced diabetes remission; being more frequent in patients of older age, and those who experienced surgical cure and those with preserved anterior pituitary function after surgery.

• Publisher: Springer US,Springer Nature B.V
• Subject: Acromegaly / Acromegaly - metabolism / Acromegaly - surgery / Adult / Aged / Diabetes / Diabetes mellitus / Diabetes Mellitus - metabolism / Diabetes Mellitus - surgery / Dyslipidemia / Endocrinology / Female / Glucose / Glucose - metabolism / Glycated Hemoglobin - metabolism / Hemoglobin / Human Physiology / Humans / Insulin-like growth factor I / Insulin-Like Growth Factor I - metabolism / Male / Medicine / Medicine & Public Health / Metabolism / Middle Aged / Multivariate analysis / Patients / Pituitary (anterior) / Pituitary Gland - metabolism / Pituitary Gland - surgery / Remission / Remission (Medicine) / Retrospective Studies / Surgery / Treatment Outcome