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Prof. Vera Popovic
Belgrade School of Medicine, University of Belgrade
Dr Subotica 6
Belgrade 11 000 (Serbia)
E-Mail [email protected]
Popovic V, Korbonits M (eds): Metabolic Syndrome Consequent to Endocrine Disorders.
Front Horm Res. Basel, Karger, 2018, vol 49, pp 20–28 (DOI: 10.1159/000486001)
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Metabolic Complications of Acromegaly
Moisés Mercado · Claudia Ramírez-Rentería
Experimental Endocrinology Unit and Endocrinology Service, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, IMSS, Mexico City, Mexico
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Abstract
Diabetes is recognized as one of the most common acromegaly co-morbidities with a prevalence ranging 20–53%, while over one-third of these patients have an altered lipid profile. In fact, as in the non-acromegalic population, carbohydrate and lipid metabolism abnormalities are closely linked. Long term exposure to an excess of growth hormone (GH) and Insulin-like growth factor-1 concentrations results in insulin resistance and an increased hepatic glucose production. The lipolytic effect of GH results in the mobilization of free fatty acids that further contributes to the decreased insulin sensitivity found in these patients. Some studies suggest that the presence of diabetes contributes to the increased mortality of acromegaly, although this remains controversial. Successful treatment of acromegaly usually results in significant, albeit incomplete improvements of the abnormal metabolic profile.
© 2018 S. Karger AG, Basel
Introduction
The chronic excess of growth hormone (GH) and insulin-like growth factor-1 (IGF-1) that occurs in acromegaly affects virtually all aspects of metabolism, including protein, lipid, and carbohydrate synthesis and degradation as well as the handling of sodium, calcium, and phosphorus by the kidney. The clinical expression of these metabolic abnormalities varies among patients and is strongly influenced by ethnogentic and environmental factors. The resulting co-morbidities, including diabetes, dyslipidemia, and hypertension, contribute to the increased cardiovascular mortality risk found in these patients. In this brief review, we analyze the pathophysiology, epidemiology, and clinical characteristics of the carbohydrate and lipid metabolism abnormalities that occur in acromegaly. For an in-depth analysis of the effects of chronic GH and IGF-1 excess on the renal handling of sodium, calcium and phosphorus we refer the reader to an excellent review by Kamenicky et al. [1].