Background: Acromegaly may result in impaired glucose metabolism. Somatostatin analogues (SSA) may themselves impair glucose metabolism by inhibiting insulin secretion. The long term impact on glucose status in patients with acromegaly treated with SSA remains unclear.
Objectives: To study the long term effect on glucose metabolism in patients with acromegaly receiving SSA versus not treated with SSA.
Methods: Retrospective chart review of 22 patients with acromegaly treated for >5 years. Patients were divided into 4 groups.
Group 1: 4 patients on primary medical therapy with SSA and biochemical control.
Group 2: 6 patients who had primary surgery with achievement of biochemical control.
Group 3: 6 patients who had primary surgery and postoperative SSA with subsequent biochemical control.
Group 4: 6 patients who had primary surgery followed by SSA and have not achieved biochemical control.
Results: The Median age of patients was 55 (30-78)yrs. Mean BMIs in group1, 2, 3 and 4 were 25, 30, 28 and 33 respectively. All patients had follow up of at least 8 years. A deterioration in glucose metabolism was seen in group 1(3 of 4 patients), group 3 and group 4(each 2 of 6 patients). No patient undergoing primary surgical treatment developed impaired glucose metabolism after long term follow-up. In group 1, one patient had baseline impaired fasting glucose and by 9 years was on Metformin. In group 3, baseline fasting glucose in one patient was 6.2mmol/L rising to 7.4mmol/L by 5-6 years of SSA despite weight loss. One patient in group 3 and two in group 4 had baseline diabetes and were on insulin therapy after SSA at the end of 8-9 years follow-up.
Conclusion: SSA treatment, either as primary medical treatment or after surgery regardless of biochemical control or weight, may be associated with a longer term deterioration in glucose metabolism compared with primary surgical management.