Acromegaly Diabetes

Prolonged exposure to elevated GH and IGP-Is can lead to serious complications in patients with acromegaly. Aggressively manage comorbid conditions such as hypertension, diabetes, arrhythmias, coronary artery disease and heart failure to prevent vascular and neuropathic complications. It is critical to monitor patients indefinitely for management of the comorbidities associated with acromegaly8 (Table 43-4). 

Uncommon causes of diabetes (1% to 2% of cases) include endocrine disorders (e.g., acromegaly, Cushing s syndrome), gestational diabetes mellitus (GDM), diseases of the exocrine pancreas (e.g., pancreatitis), and medications (e.g., glucocorticoids, pentamidine, niacin, and a-interferon). 

Atmaca A, Erbas, T. Lipoatrophy induced by subcutaneous administration of octreotide in the treatment of acromegaly. Exp Clin Endocrinol Diabetes 2005 113 340-3. 

There has been one previous report of acanthosis nigricans in a woman who received human pituitary extract (62). This condition is usually seen in hyperinsulinemic states, including diabetes mellitus and acromegaly over-stimulation at the IGF-I receptor is probably the final common pathway. 

Rowles S, Paisley A, Trainer PJ. Somastatin analogue versus growth-hormone antagonist treatment for acromegaly who should get what Curr Opin Endocrinol Diabetes 2003 10 265-71. 

In acromegaly, excess growth hormone causes diabetes, hypertension and arthritis. The former two lead to a 2-fold excess in cardiovascular mortality. Surgery is the treatment of choice. Growth hormone secretion is reduced by octreotide and other somatostatin analogues and to a lesser degree by bromocriptine (see Index). 

Endocrinopathies Excessive production of insulin counterregulatory hormones can cause diabetes mellitus. Examples include excessive production of growth hormone (acromegaly), cortisol (Cushing s syndrome), epinephrine (pheochromocytoma), and glucagon (glucago-noma). 

Type 1 DM idiopathic is a nonimmune form of diabetes frequently seen in minorities with intermittent insulin requirements. The prevalence of type 1 DM has been increasing over the last one hundred years. Maturity onset diabetes of youth (MODY), which has an identifiable genetic defect in the glucokinase gene, and endocrine disorders such as acromegaly and Cushing s syndrome, can be secondary causes of DM. These unusual etiologies, however, only account for 1% to 2% of the total cases of type 2 DM. See the section on other forms of diabetes mellitus later in this chapter for further discussion. 

Systemic metabolic or endocrine disorders Wilson s disease Acromegaly Hyperparathyroidism Hemochromatosis Paget s disease Diabetes mellitus Obesity... 

The oral glucose tolerance test (see p.. 58) is commonly used in the diagnosis of diabetes mcliitus but is also u.sed to investigate growth honnone response in acromegaly. 

As a result of the metabolic effects of GH, the clinical course of acromegaly may be complicated by impaired glucose tolerance or even overt diabetes mellitus, as occurred with Sam Atotrope. 

GH-RIH is a remarkably potent agent with a wide variety of actions. Whether it has a physiological role or not remains to be determined. Is it normally a regulator of GH secretion, or does it have wider functions outside the brain as a local regulator of endocrine and exocrine secretion These questions as well as its potential therapeutic role in acromegaly and diabetes mellitus remain to be answered. 

Abrahamson MJ. Death from diabetic ketoacidosis after cessation of octreotide in acromegaly. Lancet (1990) 336, 318-19. 

Hyperglycaemia is found in diabetes mellitus when insufficient insulin is present. This may be a primary condition or secondary to other conditions, e.g. when insulin antagonists are present in excess as in Cushing s disease (due to excess glucocorticoids), acromegaly (due to excess growth hormone) or phaeochromocytoma (due to excess adrenaline). 

Hypothyroidism, hyperthyroidism, and acromegaly can adversely affect respiratory muscle function (40). Proteolysis of myofibrillar proteins by the ubiquitin-proteasome proteolytic system is probably responsible for respiratory muscle catabolism and weakness of hyperthyroidism (40) This mechanism is implicated in the muscle wasting associated with acidosis, renal failure, cancer, diabetes, acquired immunity deficiency syndrome, trauma, and... 

---