Glucose status in patients with acromegaly receiving primary treatment with the somatostatin analog lanreotide.

To describe glucose status changes in patients with acromegaly receiving somatostatin analog lanreotide as primary treatment. This retrospective, single-center study conducted during 1996-2008, included acromegalic patients receiving primary lanreotide treatment. Baseline and last follow-up visit assessments included glucose status (according to American Diabetes Association criteria), growth hormone (GH), and insulin-like growth factor-1 (IGF-1) levels. Glucose control was considered improved when fasting plasma glucose or antidiabetic treatments were reduced, and deteriorated if fasting glucose was the same/higher but with increased antidiabetic treatments. 42 patients (median age 50 years; range 29-75 years) were included. At baseline, 26 (62%) were normoglycemic, eight (19%) had impaired glucose tolerance/fasting glycemia, and eight (19%) had diabetes mellitus; family history of diabetes mellitus was significantly associated with abnormal glucose status. At final visit, the mean (SE) lanreotide dose was 108 (21) mg/month. Median treatment duration was 23 months, range 3-138 months, and 74% of patients received the 120-mg dose. Median GH levels decreased significantly (baseline, 12 [5-20] µg/l; final visit, 2.1 [1.0-4.7] µg/l; P < 0.0001); IGF-1 levels were age- and sex-normalized in 33% of patients. Glucose control deteriorated in seven patients (17%) and improved from abnormal levels in 10 (24%). Deterioration was associated with smaller GH decreases (median change, -3.4 µg/l vs. -10.7 µg/l, P = 0.014) and improvement with trend to lower BMI and younger age. During primary lanreotide treated acromegalic patients 60% had no change, 24% had an improvement and 17% had a worsening of glucose status. Deterioration was significantly associated with smaller GH decreases during primary lanreotide treatment.

Impaired quality of life of patients with acromegaly: control of GH/IGF-I excess improves psychological subscale appearance.

INTRODUCTION: Acromegaly, a chronic disease caused by GH/IGF-I excess, has a major impact on quality of life (QoL). OBJECTIVE: To evaluate QoL of acromegalic patients in relation to control status of the disease. DESIGN AND METHODS: Single center observational study including 93 patients with acromegaly recruited to complete QoL questionnaire (AcroQol). QoL was evaluated at least 3 months after surgery and/or medical treatment. Patients were divided into two groups: controlled (I) and uncontrolled (II) according to the latest consensus acromegaly 'control' criteria and further subdivided into four subgroups according to the previous pituitary adenoma surgery (Ib and IIb) or without surgery (Ia and IIa). RESULTS: Mean GH (0.81+/-0.47 ng/ml) and IGF-I (195+/-71 ng/ml) values in group I were significantly lower than in group II (GH, 7.01+/-12.05 ng/ml and IGF-I, 513+/-316 ng/ml; P<0.001). There was no difference in total AcroQol score, physical, or psychological scales between groups I and II. However, when adjusted to age and disease duration since diagnosis, patients of group I (63+/-20%) showed an improved psychological subscale appearance than those of group II (58+/-17%; P=0.035). In group II, IGF-I level was lower after surgery (IIa=588+/-353, IIb=410+/-225 ng/ml; P<0.038), and psychological subscale appearance was significantly better in subgroup IIb (64.9+/-18.1%) than in subgroup IIa who had medical treatment (53.9+/-14.3%; P=0.009). CONCLUSION: QoL is severely impaired in acromegalic patients. Control of GH/IGF-I excess by surgery or medical treatment seems to have a positive impact on psychological subscale appearance.