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Impact of successful transsphenoidal surgery on cardiovascular risk factors in acromegaly
Marie-Lise Jaffrain-Rea1, Giuseppe Minniti, Carlo Moroni
1Department of Experimental Medicine, University of L'Aquila, L'Aquila, Italy. jaffrain.ml.rea@katamail.com
Background:
Cardiac abnormalities develop in patients with acromegaly as a consequence of effects of GH/IGF-I on the heart and related cardiovascular risk factors.
Objective:
To evaluate the possible contribution of postoperative variations in blood pressure (BP), glucose tolerance and insulin sensitivity to the cardiac improvement reported in patients who have been cured of acromegaly.
Design:
Thirty-one patients with acromegaly were studied before and 6 Months after successful transsphenoidal surgery, defined by normal age-related IGF-I concentrations and glucose-suppressed GH concentrations <1 microg/l.
Methods:
Cardiovascular parameters were assessed by Doppler echocardiography and 24-h ambulatory blood pressure monitoring. Insulin sensitivity indexes were calculated on the basis of fasting and post-load glycaemia and insulinaemia and referred to as HOMA(ISI) and OGTT(ISI), respectively.
Results:
Successful surgery was confirmed to improve left ventricular mass index (LVMI) and diastolic filling significantly. Mean 24-h systolic BP values decreased (P=0.009) and BP rhythm was restored in 12 of 15 patients with a blunted preoperative profile. Glucose tolerance normalized in patients with preoperative glucose intolerance (n=7) or diabetes mellitus (n=3). HOMA(ISI) and OGTT(ISI) increased (P=0.0001 for each parameter), indicating a marked improvement in insulin sensitivity. The postoperative reduction in LVMI correlated with increased insulin sensitivity (P<0.001 for both indexes), but not with other parameters. Improved diastolic filling correlated with the reduction in LVMI.
Conclusions:
Successful surgery in patients with acromegaly induces a significant improvement in haemodynamic and metabolic risk factors. This study suggests a direct link between insulin resistance and acromegalic cardiomyopathy.
Insights
Successful treatment for acromegaly significantly improves heart function and metabolic health. Postoperative improvements in insulin sensitivity are directly linked to reduced cardiac abnormalities in these patients.
Area of Science:
- Endocrinology
- Cardiology
- Metabolic Syndrome
Background:
- Acromegaly, caused by excess growth hormone (GH) and insulin-like growth factor-I (IGF-I), leads to cardiac abnormalities.
- Cardiovascular risk factors are also elevated in patients with acromegaly.
Purpose of the Study:
- To assess how changes in blood pressure, glucose tolerance, and insulin sensitivity after surgery impact cardiac improvements in cured acromegaly patients.
- To investigate the direct link between insulin resistance and acromegalic cardiomyopathy.
Main Methods:
- Studied 31 acromegaly patients before and 6 months after successful transsphenoidal surgery.
- Assessed cardiovascular parameters using Doppler echocardiography and 24-h ambulatory blood pressure monitoring.
- Calculated insulin sensitivity indexes (HOMA(ISI) and OGTT(ISI)) from glucose and insulin levels.
Main Results:
- Successful surgery improved left ventricular mass index (LVMI) and diastolic filling.
- Blood pressure normalized, and glucose tolerance improved in affected patients.
- Insulin sensitivity significantly increased, correlating with reduced LVMI and improved cardiac function.
Conclusions:
- Successful acromegaly treatment improves hemodynamic and metabolic risk factors.
- A direct link exists between insulin resistance and acromegalic cardiomyopathy.
- Postoperative metabolic improvements, particularly insulin sensitivity, are key to cardiac recovery.
