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Disposition Index in Active Acromegaly.

Dan Alexandru Niculescu1, Roxana Dusceac1, Andra Caragheorgheopol2

  • 1Department of Endocrinology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.

Frontiers in Endocrinology
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PubMed
Summary

In active acromegaly, impaired insulin secretion, not just reduced insulin sensitivity, primarily causes glucose intolerance. The disposition index is key to understanding this relationship in acromegaly patients.

Keywords:
acromegalydisposition indeximpaired glucose toleranceinsulin secretioninsulin sensitivity

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Area of Science:

  • Endocrinology
  • Metabolic Disorders
  • Acromegaly Pathophysiology

Background:

  • The roles of insulin sensitivity and secretion in impaired fasting glucose (IFG) and diabetes mellitus (DM) in active acromegaly remain unclear.
  • Previous studies have not utilized the intravenous glucose tolerance test (IVGTT) to assess insulin sensitivity (Si), acute insulin response (AIRg), and disposition index (DI) in this population.

Purpose of the Study:

  • To evaluate Si, AIRg, and DI using IVGTT in acromegaly patients with normal (NGT) and abnormal glucose tolerance.
  • To clarify the contribution of insulin secretion versus insulin sensitivity to glucose intolerance in active acromegaly.

Main Methods:

  • An IVGTT was conducted on 13 active acromegaly patients (8 NGT, 2 IFG, 3 DM) and 3 healthy controls.
  • Patients had elevated insulin-like growth factor-1 and basal growth hormone levels; none were on glucose- or growth hormone-lowering medications.
  • Calculated parameters included Si, AIRg, and DI.

Main Results:

  • Acromegaly patients with NGT showed lower Si but higher AIRg compared to controls.
  • DM patients exhibited severely diminished AIRg, while IFG patients maintained insulin secretion.
  • Patients with abnormal glucose tolerance (IFG + DM) had a significantly lower DI than NGT patients and healthy controls (p < 0.01).

Conclusions:

  • The disposition index indicates that impaired insulin secretion is the primary driver of glucose intolerance in active acromegaly, despite reduced insulin sensitivity.
  • Further research is needed to explore the clinical utility of DI in predicting DM development in acromegaly.