DOES REMISSION AFTER TRANSSPHENOIDAL SURGERY FOR ACROMEGALY ENSURE A RESOLUTION OF THE INCREASED “CARDIOVASCULAR RISK” OF ACTIVE ACROMEGALY? : A PROSPECTIVE STUDY IN NEWLY DIAGNOSED PATIENTS

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: SUN 88-129-Acromegaly & Prolactinoma
Clinical
Sunday, June 16, 2013: 1:45 PM-3:45 PM
Expo Halls ABC (Moscone Center)

Poster Board SUN-102
Carlos Reyes-Vidal1, Jean-Carlos Fernandez1, Eliza B. Geer2, Jeffrey N Bruce1, Kalmon D. Post3 and Pamela U Freda*4
1Columbia University, College of P & S, New York, NY, 2Mt Sinai School of Medicine, New York, NY, 3Mount Sinai Med Ctr, New York, NY, 4Columbia University College of Physicians & Surgeons, New York, NY
Active acromegaly confers an increased mortality rate that falls to near that expected when biochemical control is achieved. CV disease has been reported to be the major contributor to this, but whether remission, as defined by current criteria, truly reverses the increased CV disease risk is uncertain. In order to further examine this question we prospectively evaluated 37 newly diagnosed patients (23 men, 14 women), before and after surgery with endocrine and CV risk markers and body composition.
Patients were divided after surgery into remission, sustained normal IGF-I after surgery alone (n=25), and active, persistently elevated IGF-1 (n= 12), groups. In both groups pre-op values were compared to those at 6 mos. post-op and in the remission group pre-op were also compared to those at long term follow up (mean 3 yr).
From pre to 6 mos post-op. the remission group had increases in body weight; 92.4 ± 4.6 (mean ± SE) to 95 ± 0.5 kg (p < .0001), leptin; 11.1 ± 2.3 to 15.7 ± 2.8 µg/L (p=.0087), CRP; 0.42 ± .1 to 3.1 ± .9 mg/L (p=.006), Homocysteine; 7.6 ± .49 to 9.3  ± .48 µmol/L (p=.002) and fasting total ghrelin; 280 ± 19 pg/ml to 382 ± 21 pg/ml (p=.0001). HOMA score decreased from 3.8 ± .52 to 1.5 ± .26 (p<.0001). These changes were sustained up to 3 yr. (mean)(range 12-84 mos) post op. By contrast, pre to 6 mos after surgery the persistent active disease group had no change in weight; 90 ± 6.9 kg to 91.4 ± 7.1 kg (p=0.71), CRP; 0.79 ± .26 to 1.5  ± 1.0 mg/L (p=.42) or ghrelin;  371 ± 49 pg/ml  to 369 ± 37 pg/ml (p=0.96), but increases in leptin 7 ± 1.6 to 9.4 ± 2.1 µg/L  (p=.02) and HCY; 7.6 ±  .46 to 9.3 ± .73 µmol/L (p=.0032).  HOMA was 6.18 ± 1.7 and fell to 3.17 ± .65 (p=.07).
12 remission patients underwent body composition analysis before and after surgery. In this group % total body fat by DXA increased from 26 ± 2.9 % before to 33.5 ± 2.6 % at 1 yr. (p=0001) and to 34 ± 2.7 % at 2 yr. (p=.0007) after surgery. Visceral adipose tissue (VAT) mass by MRI increased from 1.57 ± .35 kg to 2.16 ± .48 kg (p=.02) at 1 yr. and 2.89 ± .73 kg (p=.033) at 2 yr. after surgery.
In conclusion, while insulin resistance is reduced with remission, CV risk markers rise along with increases in % fat and VAT, a profile that associates with increasing CV risk in the general population. These changes parallel a paradoxical rise in ghrelin despite the rise in fat mass. The long-term implications of these changes in the treated acromegaly population warrant further evaluation.

Nothing to Disclose: CR, JCF, EBG, JNB, KDP, PUF

*Please take note of The Endocrine Society's News Embargo Policy at http://www.endo-society.org/endo2013/media.cfm

Sources of Research Support: NIH Grants  DK064720 and DK073040 awarded to PUF; NIH Grant UL1 RR024156 awarded to the Columbia University CTSA.