Context: The effects of chronic therapy with long-acting somatostatin analogs (SSTa) on metabolic and cardiovascular parameters have been partially elucidated in acromegalic patients. Objective: The objective of this study was to compare the long-term effects of SSTa treatment and successful surgery on GH/IGF-I secretion and cardiovascular risk parameters in acromegaly. Design, Patients, and Intervention: This was a retrospective study of 36 acromegalic patients treated with SSTa and evaluated after a median of 66 mo and of 33 sex-, age-, and body mass index-matched cured patients evaluated after a similar period of remission, all from the Institute of Endocrine Sciences (Milan, Italy). Main Outcome Measures: The main outcome measures were fasting and post-oral load glucose homeostasis, Hb A1c, insulin sensitivity and secretion by several indexes, lipid profile, and blood pressure. Results: Fasting and areas under the glucose response curve rose in patients controlled (n= 29) and not controlled (n= 7) by SSTa, becoming higher than those in cured subjects. A 1% Hb A1c increase was obsd. in all nondiabetic SSTa patients, but not in cured subjects. Basal insulin secretion and resistance, evaluated by homeostasis model assessment, decreased in all SSTa patients, whereas oral glucose tolerance test-derived insulin secretion and resistance, evaluated by insulinogenic index and oral glucose tolerance test-derived insulin secretion, improved only in SSTa-treated controlled patients. Triglycerides did not change during SSTa, whereas high-d. lipoprotein cholesterol increased in SSTa-treated controlled patients. At the last visit, the contemporary presence of at least three cardiovascular risk factors was more frequent in patients treated with SSTa than in cured subjects. Conclusions: SSTa therapy induces long-lasting disease control and improvement of insulin sensitivity and high-d. lipoprotein cholesterol levels in responsive patients. The progressive glucose homeostasis alterations, obsd. independently from the degree of cure, suggest the need for glucose homeostasis and peripheral vascular complications monitoring during chronic SSTa treatment.

Comparison between six-year therapy with long-acting somatostatin analogs and successful surgery in acromegaly : effects on cardiovascular risk factors / C.L. Ronchi, V. Varca, P. Beck-Peccoz, E. Orsi, F. Donadio, A. Baccarelli, C. Giavoli, E. Ferrante, A. Lania, A. Spada, M. Arosio. - In: THE JOURNAL OF CLINICAL ENDOCRINOLOGY AND METABOLISM. - ISSN 0021-972X. - 91:1(2006), pp. 121-128. [10.1210/jc.2005-1704]

Comparison between six-year therapy with long-acting somatostatin analogs and successful surgery in acromegaly : effects on cardiovascular risk factors

C.L. Ronchi
Primo
;
P. Beck-Peccoz;E. Orsi;F. Donadio;A. Baccarelli;C. Giavoli;E. Ferrante;A. Lania;A. Spada
Penultimo
;
M. Arosio
Ultimo
2006

Abstract

Context: The effects of chronic therapy with long-acting somatostatin analogs (SSTa) on metabolic and cardiovascular parameters have been partially elucidated in acromegalic patients. Objective: The objective of this study was to compare the long-term effects of SSTa treatment and successful surgery on GH/IGF-I secretion and cardiovascular risk parameters in acromegaly. Design, Patients, and Intervention: This was a retrospective study of 36 acromegalic patients treated with SSTa and evaluated after a median of 66 mo and of 33 sex-, age-, and body mass index-matched cured patients evaluated after a similar period of remission, all from the Institute of Endocrine Sciences (Milan, Italy). Main Outcome Measures: The main outcome measures were fasting and post-oral load glucose homeostasis, Hb A1c, insulin sensitivity and secretion by several indexes, lipid profile, and blood pressure. Results: Fasting and areas under the glucose response curve rose in patients controlled (n= 29) and not controlled (n= 7) by SSTa, becoming higher than those in cured subjects. A 1% Hb A1c increase was obsd. in all nondiabetic SSTa patients, but not in cured subjects. Basal insulin secretion and resistance, evaluated by homeostasis model assessment, decreased in all SSTa patients, whereas oral glucose tolerance test-derived insulin secretion and resistance, evaluated by insulinogenic index and oral glucose tolerance test-derived insulin secretion, improved only in SSTa-treated controlled patients. Triglycerides did not change during SSTa, whereas high-d. lipoprotein cholesterol increased in SSTa-treated controlled patients. At the last visit, the contemporary presence of at least three cardiovascular risk factors was more frequent in patients treated with SSTa than in cured subjects. Conclusions: SSTa therapy induces long-lasting disease control and improvement of insulin sensitivity and high-d. lipoprotein cholesterol levels in responsive patients. The progressive glucose homeostasis alterations, obsd. independently from the degree of cure, suggest the need for glucose homeostasis and peripheral vascular complications monitoring during chronic SSTa treatment.
Acromegaly ; Blood pressure ; Human ; Surgery (comparison between six-year therapy with long-acting somatostatin analogs vs. successful surgery in patients with acromegaly and effects on cardiovascular risk factors) ; Fibrinogens ; Glycerides ; High-density lipoproteins ; Lipids ; Low-density lipoproteins Role: BSU (Biological study, unclassified), BIOL (Biological study) (comparison between six-year therapy with long-acting somatostatin analogs vs. successful surgery in patients with acromegaly and effects on cardiovascular risk factors) ; Diabetes mellitus (development of ; comparison between six-year therapy with long-acting somatostatin analogs vs. successful surgery in patients with acromegaly and effects on cardiovascular risk factors) ; Dyslipidemia Role: BSU (Biological study, unclassified), BIOL (Biological study) (history of ; comparison between six-year therapy with long-acting somatostatin analogs vs. successful surgery in patients with acromegaly and effects on cardiovascular risk factors) ; Blood vessel (peripheral, risk for ; comparison between six-year therapy with long-acting somatostatin analogs vs. successful surgery in patients with acromegaly and effects on cardiovascular risk factors) ; Cardiovascular system (risk for ; comparison between six-year therapy with long-acting somatostatin analogs vs. successful surgery in patients with acromegaly and effects on cardiovascular risk factors) ; Drug delivery systems (sustained-release ; comparison between six-year therapy with long-acting somatostatin analogs vs. successful surgery in patients with acromegaly and effects on cardiovascular risk factors)
Settore MED/44 - Medicina del Lavoro
Settore MED/13 - Endocrinologia
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2434/23281
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