The natural history of glucose intolerance (GI) in patients with acromegaly undergoing surgical treatment is yet to be completely understood. A recent study described the prevalence and predictors of recovery from GI in these patients in a prospective multivariate model.

Patients with acromegaly were studied for demographics, clinico-radiological features, comorbidities, and hormonal investigations before surgery and at regular follow-up. The independent predictors of recovery from diabetes were investigated.

The observations were as follows-

• 151 patients with active acromegaly were included in the study. The median baseline growth hormone (GH) and insulin-like growth factor (IGF)-1 levels were noted as 25 and 811 ng/mL, respectively.
• Diabetes mellitus (DM) and pre-diabetes were found in 61.6% and 13.2% of patients, respectively.
• After surgical treatment, the median HbA1c showed a significant reduction from 6.4% to 5.5%, with 46.8% having a full recovery from DM or pre-diabetes.
• This glycemic recovery showed a significant association with both biochemical and radiological remission.
• The recovery from DM showed a closer association with post-operative IGF-1 than GH, particularly among those with discordant GH and IGF-1 levels.
• Post-operative IGF-1 showed a notable effect on recovery from DM irrespective of age, body mass index, duration of DM, and pre-operative HbA1c.

Thus, about 50% of the patients with acromegaly with DM or pre-diabetes experienced glycemic recovery, influenced by biochemical and radiologic remission. Post-operative IGF-1 may be the most emphatic independent determinant of recovery from DM.

Source: Neurol India. 2019 May-Jun;67(3):757-762. doi: 10.4103/0028-3886.263242. PMID: 31347550.