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