Therapy of acromegalic patients exacerbated by concomitant type 2 diabetes requires higher pegvisomant doses to normalise IGF1 levels
ObjectiveAcromegaly is associated with an increased prevalence of glucose metabolism disorders. Clinically confirmed diabetes mellitus is observed in approximately one quarter of all patients with acromegaly and is known to have a worse prognosis in these patients.DesignOf 514 acromegalic patients t...
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| Veröffentlicht in: | European journal of endocrinology 2014-07, Vol.171 (1), p.59-68 |
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| container_title | European journal of endocrinology |
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| creator | Droste, Michael Domberg, Julia Buchfelder, Michael Mann, Klaus Schwanke, Anja Stalla, Günter Strasburger, Christian J |
| description | ObjectiveAcromegaly is associated with an increased prevalence of glucose metabolism disorders. Clinically confirmed diabetes mellitus is observed in approximately one quarter of all patients with acromegaly and is known to have a worse prognosis in these patients.DesignOf 514 acromegalic patients treated with pegvisomant and recorded in the German Cohort of ACROSTUDY, 147 had concomitant diabetes mellitus. We analysed these patients in an observational study and compared patients with and without concomitant diabetes.ResultsUnder treatment with pegvisomant, patients with diabetes mellitus rarely achieved normalisation (64% in the diabetic cohort vs 75% in the non-diabetic cohort, P=0.04) for IGF1. Diabetic patients normalised for IGF1 required higher pegvisomant doses (18.9 vs 15.5 mg pegvisomant/day, P |
| doi_str_mv | 10.1530/EJE-13-0438 |
| format | Article |
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Clinically confirmed diabetes mellitus is observed in approximately one quarter of all patients with acromegaly and is known to have a worse prognosis in these patients.DesignOf 514 acromegalic patients treated with pegvisomant and recorded in the German Cohort of ACROSTUDY, 147 had concomitant diabetes mellitus. We analysed these patients in an observational study and compared patients with and without concomitant diabetes.ResultsUnder treatment with pegvisomant, patients with diabetes mellitus rarely achieved normalisation (64% in the diabetic cohort vs 75% in the non-diabetic cohort, P=0.04) for IGF1. Diabetic patients normalised for IGF1 required higher pegvisomant doses (18.9 vs 15.5 mg pegvisomant/day, P<0.01). Furthermore, those diabetic patients requiring insulin therapy showed a tendency towards requiring even higher pegvisomant doses to normalise IGF1 values than diabetic patients receiving only oral treatment (22.8 vs 17.2 mg pegvisomant/day, P=0.11).ConclusionsHence, notable interdependences between the acromegaly, the glucose metabolism of predisposed patients and their treatment with pegvisomant were observed. Our data support recent findings suggesting that intra-portal insulin levels determine the GH receptor expression in the liver underlined by the fact that patients with concomitant diabetes mellitus, in particular those receiving insulin therapy, require higher pegvisomant doses to normalise IGF1. It is therefore important to analyse various therapy modalities to find out whether they influence the associated diabetes mellitus and/or whether the presence of diabetes mellitus influences the treatment results of an acromegaly therapy.</description><identifier>ISSN: 0804-4643</identifier><identifier>EISSN: 1479-683X</identifier><identifier>DOI: 10.1530/EJE-13-0438</identifier><identifier>PMID: 24913198</identifier><language>eng</language><publisher>Bristol: Bioscientifica Ltd</publisher><subject>Acromegaly - drug therapy ; Acromegaly - metabolism ; Aged ; Biological and medical sciences ; Clinical Study ; Diabetes Mellitus, Type 2 - drug therapy ; Diabetes. Impaired glucose tolerance ; Endocrine pancreas. Apud cells (diseases) ; Endocrinopathies ; Etiopathogenesis. Screening. Investigations. Target tissue resistance ; Female ; Fundamental and applied biological sciences. Psychology ; Human Growth Hormone - administration & dosage ; Human Growth Hormone - analogs & derivatives ; Human Growth Hormone - therapeutic use ; Humans ; Hypothalamus. Hypophysis. Epiphysis (diseases) ; Insulin-Like Growth Factor I - metabolism ; Male ; Medical sciences ; Non tumoral diseases. Target tissue resistance. Benign neoplasms ; Retrospective Studies ; Vertebrates: endocrinology</subject><ispartof>European journal of endocrinology, 2014-07, Vol.171 (1), p.59-68</ispartof><rights>2014 European Society of Endocrinology</rights><rights>2015 INIST-CNRS</rights><rights>2014 European Society of Endocrinology.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b398t-562af4c3569e44d4de8aa7c7fde56182e07657a2135d097255eaae4f0ed72fb23</citedby><cites>FETCH-LOGICAL-b398t-562af4c3569e44d4de8aa7c7fde56182e07657a2135d097255eaae4f0ed72fb23</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27923,27924</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=28696527$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24913198$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Droste, Michael</creatorcontrib><creatorcontrib>Domberg, Julia</creatorcontrib><creatorcontrib>Buchfelder, Michael</creatorcontrib><creatorcontrib>Mann, Klaus</creatorcontrib><creatorcontrib>Schwanke, Anja</creatorcontrib><creatorcontrib>Stalla, Günter</creatorcontrib><creatorcontrib>Strasburger, Christian J</creatorcontrib><title>Therapy of acromegalic patients exacerbated by concomitant type 2 diabetes requires higher pegvisomant doses to normalise IGF1 levels</title><title>European journal of endocrinology</title><addtitle>Eur J Endocrinol</addtitle><description>ObjectiveAcromegaly is associated with an increased prevalence of glucose metabolism disorders. Clinically confirmed diabetes mellitus is observed in approximately one quarter of all patients with acromegaly and is known to have a worse prognosis in these patients.DesignOf 514 acromegalic patients treated with pegvisomant and recorded in the German Cohort of ACROSTUDY, 147 had concomitant diabetes mellitus. We analysed these patients in an observational study and compared patients with and without concomitant diabetes.ResultsUnder treatment with pegvisomant, patients with diabetes mellitus rarely achieved normalisation (64% in the diabetic cohort vs 75% in the non-diabetic cohort, P=0.04) for IGF1. Diabetic patients normalised for IGF1 required higher pegvisomant doses (18.9 vs 15.5 mg pegvisomant/day, P<0.01). Furthermore, those diabetic patients requiring insulin therapy showed a tendency towards requiring even higher pegvisomant doses to normalise IGF1 values than diabetic patients receiving only oral treatment (22.8 vs 17.2 mg pegvisomant/day, P=0.11).ConclusionsHence, notable interdependences between the acromegaly, the glucose metabolism of predisposed patients and their treatment with pegvisomant were observed. Our data support recent findings suggesting that intra-portal insulin levels determine the GH receptor expression in the liver underlined by the fact that patients with concomitant diabetes mellitus, in particular those receiving insulin therapy, require higher pegvisomant doses to normalise IGF1. It is therefore important to analyse various therapy modalities to find out whether they influence the associated diabetes mellitus and/or whether the presence of diabetes mellitus influences the treatment results of an acromegaly therapy.</description><subject>Acromegaly - drug therapy</subject><subject>Acromegaly - metabolism</subject><subject>Aged</subject><subject>Biological and medical sciences</subject><subject>Clinical Study</subject><subject>Diabetes Mellitus, Type 2 - drug therapy</subject><subject>Diabetes. Impaired glucose tolerance</subject><subject>Endocrine pancreas. Apud cells (diseases)</subject><subject>Endocrinopathies</subject><subject>Etiopathogenesis. Screening. Investigations. Target tissue resistance</subject><subject>Female</subject><subject>Fundamental and applied biological sciences. Psychology</subject><subject>Human Growth Hormone - administration & dosage</subject><subject>Human Growth Hormone - analogs & derivatives</subject><subject>Human Growth Hormone - therapeutic use</subject><subject>Humans</subject><subject>Hypothalamus. Hypophysis. Epiphysis (diseases)</subject><subject>Insulin-Like Growth Factor I - metabolism</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Non tumoral diseases. Target tissue resistance. Benign neoplasms</subject><subject>Retrospective Studies</subject><subject>Vertebrates: endocrinology</subject><issn>0804-4643</issn><issn>1479-683X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp90U1r3DAQBmBRGppt2lPvRZdCIbjVt-1jCZs0JZBLCr2ZsTTeqNiWI2lD9wf0f0fLbtJbTxrQwzvwDiEfOPvCtWRf1z_WFZcVU7J5RVZc1W1lGvnrNVmxhqlKGSVPyduUfjPGy8zekFOhWi5526zI37t7jLDsaBgo2Bgm3MDoLV0ge5xzovgHLMYeMjra76gNsw2TzzBnmncLUkGdhx4zJhrxYetjGe79pqTSBTePPoVpb11I5SMHOoc4lQ0J6fXVJacjPuKY3pGTAcaE74_vGfl5ub67-F7d3F5dX3y7qXrZNrnSRsCgrNSmRaWcctgA1LYeHGrDG4GsNroGwaV2rK2F1giAamDoajH0Qp6Rz4fcJYaHLabcTT5ZHEeYMWxTV_os9RmuVaHnB1pKSSni0C3RTxB3HWd7x7rSe8dlt--96I_H4G0_oXuxz0UX8OkIIFkYhwiz9emfa0xrtKiL4wfX-5Ds_gR-8Bb-u_wJVz2c8g</recordid><startdate>20140701</startdate><enddate>20140701</enddate><creator>Droste, Michael</creator><creator>Domberg, Julia</creator><creator>Buchfelder, Michael</creator><creator>Mann, Klaus</creator><creator>Schwanke, Anja</creator><creator>Stalla, Günter</creator><creator>Strasburger, Christian J</creator><general>Bioscientifica Ltd</general><general>BioScientifica</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20140701</creationdate><title>Therapy of acromegalic patients exacerbated by concomitant type 2 diabetes requires higher pegvisomant doses to normalise IGF1 levels</title><author>Droste, Michael ; Domberg, Julia ; Buchfelder, Michael ; Mann, Klaus ; Schwanke, Anja ; Stalla, Günter ; Strasburger, Christian J</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b398t-562af4c3569e44d4de8aa7c7fde56182e07657a2135d097255eaae4f0ed72fb23</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Acromegaly - drug therapy</topic><topic>Acromegaly - metabolism</topic><topic>Aged</topic><topic>Biological and medical sciences</topic><topic>Clinical Study</topic><topic>Diabetes Mellitus, Type 2 - drug therapy</topic><topic>Diabetes. Impaired glucose tolerance</topic><topic>Endocrine pancreas. Apud cells (diseases)</topic><topic>Endocrinopathies</topic><topic>Etiopathogenesis. Screening. Investigations. Target tissue resistance</topic><topic>Female</topic><topic>Fundamental and applied biological sciences. Psychology</topic><topic>Human Growth Hormone - administration & dosage</topic><topic>Human Growth Hormone - analogs & derivatives</topic><topic>Human Growth Hormone - therapeutic use</topic><topic>Humans</topic><topic>Hypothalamus. Hypophysis. Epiphysis (diseases)</topic><topic>Insulin-Like Growth Factor I - metabolism</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Non tumoral diseases. Target tissue resistance. Benign neoplasms</topic><topic>Retrospective Studies</topic><topic>Vertebrates: endocrinology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Droste, Michael</creatorcontrib><creatorcontrib>Domberg, Julia</creatorcontrib><creatorcontrib>Buchfelder, Michael</creatorcontrib><creatorcontrib>Mann, Klaus</creatorcontrib><creatorcontrib>Schwanke, Anja</creatorcontrib><creatorcontrib>Stalla, Günter</creatorcontrib><creatorcontrib>Strasburger, Christian J</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>European journal of endocrinology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Droste, Michael</au><au>Domberg, Julia</au><au>Buchfelder, Michael</au><au>Mann, Klaus</au><au>Schwanke, Anja</au><au>Stalla, Günter</au><au>Strasburger, Christian J</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Therapy of acromegalic patients exacerbated by concomitant type 2 diabetes requires higher pegvisomant doses to normalise IGF1 levels</atitle><jtitle>European journal of endocrinology</jtitle><addtitle>Eur J Endocrinol</addtitle><date>2014-07-01</date><risdate>2014</risdate><volume>171</volume><issue>1</issue><spage>59</spage><epage>68</epage><pages>59-68</pages><issn>0804-4643</issn><eissn>1479-683X</eissn><abstract>ObjectiveAcromegaly is associated with an increased prevalence of glucose metabolism disorders. Clinically confirmed diabetes mellitus is observed in approximately one quarter of all patients with acromegaly and is known to have a worse prognosis in these patients.DesignOf 514 acromegalic patients treated with pegvisomant and recorded in the German Cohort of ACROSTUDY, 147 had concomitant diabetes mellitus. We analysed these patients in an observational study and compared patients with and without concomitant diabetes.ResultsUnder treatment with pegvisomant, patients with diabetes mellitus rarely achieved normalisation (64% in the diabetic cohort vs 75% in the non-diabetic cohort, P=0.04) for IGF1. Diabetic patients normalised for IGF1 required higher pegvisomant doses (18.9 vs 15.5 mg pegvisomant/day, P<0.01). Furthermore, those diabetic patients requiring insulin therapy showed a tendency towards requiring even higher pegvisomant doses to normalise IGF1 values than diabetic patients receiving only oral treatment (22.8 vs 17.2 mg pegvisomant/day, P=0.11).ConclusionsHence, notable interdependences between the acromegaly, the glucose metabolism of predisposed patients and their treatment with pegvisomant were observed. Our data support recent findings suggesting that intra-portal insulin levels determine the GH receptor expression in the liver underlined by the fact that patients with concomitant diabetes mellitus, in particular those receiving insulin therapy, require higher pegvisomant doses to normalise IGF1. It is therefore important to analyse various therapy modalities to find out whether they influence the associated diabetes mellitus and/or whether the presence of diabetes mellitus influences the treatment results of an acromegaly therapy.</abstract><cop>Bristol</cop><pub>Bioscientifica Ltd</pub><pmid>24913198</pmid><doi>10.1530/EJE-13-0438</doi><tpages>10</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | European journal of endocrinology, 2014-07, Vol.171 (1), p.59-68 |
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| source | MEDLINE; Oxford University Press Journals All Titles (1996-Current) |
| subjects | Acromegaly - drug therapy Acromegaly - metabolism Aged Biological and medical sciences Clinical Study Diabetes Mellitus, Type 2 - drug therapy Diabetes. Impaired glucose tolerance Endocrine pancreas. Apud cells (diseases) Endocrinopathies Etiopathogenesis. Screening. Investigations. Target tissue resistance Female Fundamental and applied biological sciences. Psychology Human Growth Hormone - administration & dosage Human Growth Hormone - analogs & derivatives Human Growth Hormone - therapeutic use Humans Hypothalamus. Hypophysis. Epiphysis (diseases) Insulin-Like Growth Factor I - metabolism Male Medical sciences Non tumoral diseases. Target tissue resistance. Benign neoplasms Retrospective Studies Vertebrates: endocrinology |
| title | Therapy of acromegalic patients exacerbated by concomitant type 2 diabetes requires higher pegvisomant doses to normalise IGF1 levels |
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