Diabetes mellitus in acromegaly: prevalence, pathophysiological particulars and treatment strategies
The prevalence of diabetes mellitus in acromegaly is significantly higher than that in the general population. Carbohydrate metabolism abnormalities often precede other phenotypic manifestations of acromegaly. The review presents data on the prevalence of carbohydrate metabolism disorders in acromeg...
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| Format: | Article |
| Language: | Russian |
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MONIKI
2023-12-01
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| Series: | Alʹmanah Kliničeskoj Mediciny |
| Subjects: | |
| Online Access: | https://almclinmed.ru/jour/article/viewFile/17161/1618 |
| _version_ | 1797261484312494080 |
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| author | Irena A. Ilovayskaya Gagik R. Galstyan |
| author_facet | Irena A. Ilovayskaya Gagik R. Galstyan |
| author_sort | Irena A. Ilovayskaya |
| collection | DOAJ |
| description | The prevalence of diabetes mellitus in acromegaly is significantly higher than that in the general population. Carbohydrate metabolism abnormalities often precede other phenotypic manifestations of acromegaly. The review presents data on the prevalence of carbohydrate metabolism disorders in acromegaly and describes their pathophysiological characteristics and approaches to treatment.
Growth hormone (GH) excess is recognized as a key factor of glucose homeostasis abnormalities due to decreased insulin sensitivity (resulting from active lipolysis) and direct stimulation of insulin secretion. Insulin-like growth factor 1 (IGF1) improves insulin sensitivity; however, the GH diabetogenic effects prevail over the insulin-sensitizing impact of IGF1. Surgical and radiation treatment for somatotropinoma may indirectly improve carbohydrate metabolism, because they decrease the GH levels. Treatment with first generation somatostatin analogues can both improve glycemic control due to decreased GH levels and worsen it due to deterioration of postprandial insulin release, especially in patients with already manifest carbohydrate metabolism disorders. The GH receptor antagonist pegvisomant blocks the effects of excess GH on the target tissues without suppressing insulin secretion, which results in better glucose control; treatment with this agent can be preferred in patients with acromegaly and diabetes mellitus. Management of carbohydrate metabolism disorders in acromegaly is done in accordance with general treatment principles for type 2 diabetes mellitus. |
| first_indexed | 2024-04-24T23:41:57Z |
| format | Article |
| id | doaj.art-16e53b523e38429183f494b632d99453 |
| institution | Directory Open Access Journal |
| issn | 2072-0505 2587-9294 |
| language | Russian |
| last_indexed | 2024-04-24T23:41:57Z |
| publishDate | 2023-12-01 |
| publisher | MONIKI |
| record_format | Article |
| series | Alʹmanah Kliničeskoj Mediciny |
| spelling | doaj.art-16e53b523e38429183f494b632d994532024-03-15T10:27:23ZrusMONIKIAlʹmanah Kliničeskoj Mediciny2072-05052587-92942023-12-0151634435410.18786/2072-0505-2023-51-037961Diabetes mellitus in acromegaly: prevalence, pathophysiological particulars and treatment strategiesIrena A. Ilovayskaya0https://orcid.org/0000-0003-3261-7366Gagik R. Galstyan1https://orcid.org/0000-0001-6581-4521Moscow Regional Research and Clinical Institute (MONIKI)Moscow Regional Research and Clinical Institute (MONIKI)The prevalence of diabetes mellitus in acromegaly is significantly higher than that in the general population. Carbohydrate metabolism abnormalities often precede other phenotypic manifestations of acromegaly. The review presents data on the prevalence of carbohydrate metabolism disorders in acromegaly and describes their pathophysiological characteristics and approaches to treatment. Growth hormone (GH) excess is recognized as a key factor of glucose homeostasis abnormalities due to decreased insulin sensitivity (resulting from active lipolysis) and direct stimulation of insulin secretion. Insulin-like growth factor 1 (IGF1) improves insulin sensitivity; however, the GH diabetogenic effects prevail over the insulin-sensitizing impact of IGF1. Surgical and radiation treatment for somatotropinoma may indirectly improve carbohydrate metabolism, because they decrease the GH levels. Treatment with first generation somatostatin analogues can both improve glycemic control due to decreased GH levels and worsen it due to deterioration of postprandial insulin release, especially in patients with already manifest carbohydrate metabolism disorders. The GH receptor antagonist pegvisomant blocks the effects of excess GH on the target tissues without suppressing insulin secretion, which results in better glucose control; treatment with this agent can be preferred in patients with acromegaly and diabetes mellitus. Management of carbohydrate metabolism disorders in acromegaly is done in accordance with general treatment principles for type 2 diabetes mellitus.https://almclinmed.ru/jour/article/viewFile/17161/1618acromegalycarbohydrate metabolism disordersdiabetes mellitusgrowth hormonesomatotropinomasomatostatin analoguesgrowth hormone receptor antagonist |
| spellingShingle | Irena A. Ilovayskaya Gagik R. Galstyan Diabetes mellitus in acromegaly: prevalence, pathophysiological particulars and treatment strategies Alʹmanah Kliničeskoj Mediciny acromegaly carbohydrate metabolism disorders diabetes mellitus growth hormone somatotropinoma somatostatin analogues growth hormone receptor antagonist |
| title | Diabetes mellitus in acromegaly: prevalence, pathophysiological particulars and treatment strategies |
| title_full | Diabetes mellitus in acromegaly: prevalence, pathophysiological particulars and treatment strategies |
| title_fullStr | Diabetes mellitus in acromegaly: prevalence, pathophysiological particulars and treatment strategies |
| title_full_unstemmed | Diabetes mellitus in acromegaly: prevalence, pathophysiological particulars and treatment strategies |
| title_short | Diabetes mellitus in acromegaly: prevalence, pathophysiological particulars and treatment strategies |
| title_sort | diabetes mellitus in acromegaly prevalence pathophysiological particulars and treatment strategies |
| topic | acromegaly carbohydrate metabolism disorders diabetes mellitus growth hormone somatotropinoma somatostatin analogues growth hormone receptor antagonist |
| url | https://almclinmed.ru/jour/article/viewFile/17161/1618 |
| work_keys_str_mv | AT irenaailovayskaya diabetesmellitusinacromegalyprevalencepathophysiologicalparticularsandtreatmentstrategies AT gagikrgalstyan diabetesmellitusinacromegalyprevalencepathophysiologicalparticularsandtreatmentstrategies |