Glucose intolerance in acromegaly is driven by low insulin secretion; results from an intravenous glucose tolerance test.

IF 3.3 2区医学 Q2 ENDOCRINOLOGY & METABOLISM

Pituitary Pub Date : 2024-04-01 Epub Date: 2024-02-21 DOI:10.1007/s11102-024-01386-z

Laura Georgiana Zaifu, Dan Alexandru Niculescu, Andreea Elena Kremer, Andra Caragheorgheopol, Mariana Sava, Carmen Nicoleta Iordachescu, Roxana Dusceac, Iulia Florentina Burcea, Catalina Poiana

{"title":"Glucose intolerance in acromegaly is driven by low insulin secretion; results from an intravenous glucose tolerance test.","authors":"Laura Georgiana Zaifu, Dan Alexandru Niculescu, Andreea Elena Kremer, Andra Caragheorgheopol, Mariana Sava, Carmen Nicoleta Iordachescu, Roxana Dusceac, Iulia Florentina Burcea, Catalina Poiana","doi":"10.1007/s11102-024-01386-z","DOIUrl":null,"url":null,"abstract":"Purpose: Insulin sensitivity (Si) and its role in glucose intolerance of acromegaly has been extensively evaluated. However, data on insulin secretion is limited. We aimed to assess stimulated insulin secretion using an intravenous glucose tolerance test (IVGTT) in active acromegaly.Methods: We performed an IVGTT in 25 patients with active acromegaly (13 normal glucose tolerance [NGT], 6 impaired glucose tolerance [IGT] and 6 diabetes mellitus [DM]) and 23 controls (8 lean NGT, 8 obese NGT and 7 obese IGT). Serum glucose and insulin were measured at 20 time points along the test to calculate Si and acute insulin response (AIRg). Medical treatment for acromegaly or diabetes was not allowed.Results: In acromegaly, patients with NGT had significantly (p for trend < 0.001) higher AIRg (3383 ± 1082 pmol*min/L) than IGT (1215 ± 1069) and DM (506 ± 600). AIRg was higher in NGT (4764 ± 1180 pmol*min/L) and IGT (3183 ± 3261) controls with obesity than NGT (p = 0.01) or IGT (p = 0.17) acromegaly. Si was not significantly lower in IGT (0.68 [0.37, 0.88] 106*L/pmol*min) and DM (0.60 [0.42, 0.84]) than in NGT (0.81 [0.58, 1.55]) patients with acromegaly. NGT (0.33 [0.30, 0.47] 106*L/pmol*min) and IGT (0.37 [0.21, 0.66]) controls with obesity had lower Si than NGT (p = 0.001) and IGT (p = 0.43) acromegaly.Conclusion: We demonstrated that low insulin secretion is the main driver behind glucose intolerance in acromegaly. Compared to NGT and IGT controls with obesity, patients with NGT or IGT acromegaly had higher Si. Together, these findings suggest that impaired insulin secretion might be a specific mechanism for glucose intolerance in acromegaly.","PeriodicalId":20202,"journal":{"name":"Pituitary","volume":null,"pages":null},"PeriodicalIF":3.3000,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Pituitary","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s11102-024-01386-z","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/2/21 0:00:00","PubModel":"Epub","JCR":"Q2","JCRName":"ENDOCRINOLOGY & METABOLISM","Score":null,"Total":0}

引用次数: 0

Abstract

Purpose: Insulin sensitivity (S_i) and its role in glucose intolerance of acromegaly has been extensively evaluated. However, data on insulin secretion is limited. We aimed to assess stimulated insulin secretion using an intravenous glucose tolerance test (IVGTT) in active acromegaly.

Methods: We performed an IVGTT in 25 patients with active acromegaly (13 normal glucose tolerance [NGT], 6 impaired glucose tolerance [IGT] and 6 diabetes mellitus [DM]) and 23 controls (8 lean NGT, 8 obese NGT and 7 obese IGT). Serum glucose and insulin were measured at 20 time points along the test to calculate S_i and acute insulin response (AIRg). Medical treatment for acromegaly or diabetes was not allowed.

Results: In acromegaly, patients with NGT had significantly (p for trend < 0.001) higher AIRg (3383 ± 1082 pmol*min/L) than IGT (1215 ± 1069) and DM (506 ± 600). AIRg was higher in NGT (4764 ± 1180 pmol*min/L) and IGT (3183 ± 3261) controls with obesity than NGT (p = 0.01) or IGT (p = 0.17) acromegaly. S_i was not significantly lower in IGT (0.68 [0.37, 0.88] 10⁶*L/pmol*min) and DM (0.60 [0.42, 0.84]) than in NGT (0.81 [0.58, 1.55]) patients with acromegaly. NGT (0.33 [0.30, 0.47] 10⁶*L/pmol*min) and IGT (0.37 [0.21, 0.66]) controls with obesity had lower S_i than NGT (p = 0.001) and IGT (p = 0.43) acromegaly.

Conclusion: We demonstrated that low insulin secretion is the main driver behind glucose intolerance in acromegaly. Compared to NGT and IGT controls with obesity, patients with NGT or IGT acromegaly had higher S_i. Together, these findings suggest that impaired insulin secretion might be a specific mechanism for glucose intolerance in acromegaly.

Abstract Image

查看原文本刊更多论文

胰岛素分泌不足导致肢端肥大症患者出现葡萄糖不耐受；静脉葡萄糖耐量试验的结果。

目的：胰岛素敏感性（Si）及其在肢端肥大症葡萄糖不耐受中的作用已得到广泛评估。然而，有关胰岛素分泌的数据却很有限。我们旨在通过静脉葡萄糖耐量试验（IVGTT）评估活动性肢端肥大症患者的刺激性胰岛素分泌情况：我们对 25 例活动性肢端肥大症患者（13 例糖耐量正常 [NGT]、6 例糖耐量受损 [IGT] 和 6 例糖尿病 [DM]）和 23 例对照组（8 例瘦弱 NGT、8 例肥胖 NGT 和 7 例肥胖 IGT）进行了静脉葡萄糖耐量试验（IVGTT）。在测试的 20 个时间点测量血清葡萄糖和胰岛素，以计算 Si 和急性胰岛素反应（AIRg）。不允许对肢端肥大症或糖尿病进行药物治疗：在肢端肥大症患者中，IGT（0.68 [0.37, 0.88] 106*L/pmol*min）和DM（0.60 [0.42, 0.84]）患者的NGT（0.81 [0.58, 1.55]）显著低于NGT（0.68 [0.37, 0.88] 106*L/pmol*min）患者（p为趋势i）。肥胖的 NGT（0.33 [0.30, 0.47] 106*L/pmol*min）和 IGT（0.37 [0.21, 0.66]）对照组的 Si 值低于 NGT（p = 0.001）和 IGT（p = 0.43）肢端肥大症患者：我们证明，胰岛素分泌不足是肢端肥大症患者葡萄糖不耐受的主要原因。与肥胖的 NGT 和 IGT 对照组相比，肢端肥大症 NGT 或 IGT 患者的 Si 值更高。这些发现共同表明，胰岛素分泌受损可能是导致肢端肥大症患者糖耐量减低的一个特殊机制。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Pituitary 医学-内分泌学与代谢

CiteScore

7.10

自引率

7.90%

发文量

审稿时长

6 months

期刊介绍： Pituitary is an international publication devoted to basic and clinical aspects of the pituitary gland. It is designed to publish original, high quality research in both basic and pituitary function as well as clinical pituitary disease. The journal considers: Biology of Pituitary Tumors Mechanisms of Pituitary Hormone Secretion Regulation of Pituitary Function Prospective Clinical Studies of Pituitary Disease Critical Basic and Clinical Reviews Pituitary is directed at basic investigators, physiologists, clinical adult and pediatric endocrinologists, neurosurgeons and reproductive endocrinologists interested in the broad field of the pituitary and its disorders. The Editorial Board has been drawn from international experts in basic and clinical endocrinology. The journal offers a rapid turnaround time for review of manuscripts, and the high standard of the journal is maintained by a selective peer-review process which aims to publish only the highest quality manuscripts. Pituitary will foster the publication of creative scholarship as it pertains to the pituitary and will provide a forum for basic scientists and clinicians to publish their high quality pituitary-related work.