Glucose metabolism outcomes after pituitary surgery in patients with acromegaly

期刊论文
发表日期：

2024年6月28日

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

摘要

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.