Glucose metabolism outcomes after pituitary surgery in patients with acromegaly

Abstract

Aim: To investigate the impact of pituitary surgery on glucose metabolism and to identify predictors of remission of diabetes after pituitary surgery in patients with acromegaly. Methods: A national multicenter retrospective study of patients with acromegaly undergoing transsphenoidal surgery for the first time at 33 tertiary Spanish hospitals (ACRO-SPAIN study) was performed. Surgical remission of acromegaly was evaluated according to the 2000 and 2010 criteria. Results: A total of 604 acromegaly patients were included in the study with a total median follow up of 91 months (interquartile range [IQR] 45-163). At the acromegaly diagnosis, 23.8% of the patients had type 2 diabetes mellitus (T2DM) with a median glycated hemoglobin (HbA1c) of 6.9% (IQR 6.4-7.9). In the multivariate analysis, older age (odds ratio [OR] 1.02, 95% CI 1.00-1.05), dyslipidemia (OR 5.25, 95% CI 2.81 to 9.79), artropathy (OR 1.39, 95% CI 2.82 to 9.79), and higher IGF-1 levels (OR 1.30, 95% CI 1.05 to 1.60) were associated with a greater prevalence of T2DM. At the last follow-up visit after surgery, 21.1% of the T2DM patients (56.7% of them with surgical remission of acromegaly) experienced diabetes remission. The cure rate of T2DM was more common in older patients (hazard ratio [HR] 1.77, 95% CI 1.31 to 2.43), when surgical cure was achieved (HR 2.10, 95% CI 1.01 to 4.37) and when anterior pituitary function was not affected after surgery (HR 3.38, 95% CI 1.17 to 9.75). Conclusion: Glucose metabolism improved in patients with acromegaly after surgery and 21% of the diabetic patients experienced diabetes remission; being more frequent in patients of older age, and those who experienced surgical cure and those with preserved anterior pituitary function after surgery.