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Consider microalbuminuria when assessing patients with acromegaly
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In patients with acromegaly, impaired glucose tolerance is linked to high levels of microalbuminuria. As a result, when assessing for cardiovascular risks in these patients, microalbuminuria should be considered, according to data published in the Journal of Clinical Endocrinology and Metabolism.
Researchers in Italy conducted an observational, multicenter, open prospective study of 74 patients with active acromegaly (normal glucose tolerance, n=52; impaired glucose tolerance, n=16; diabetes, n=6) and 50 controls.
In the entire population, mean GH levels were 24.2±3.9 ng/ml and insulin-like growth factor I levels were 700.1±23.0 mcg/liter. Compared with controls, patients had lower insulin sensitivity index (P<.0005). Those with impaired glucose tolerance and diabetes had higher microalbuminuria than those with normal glucose tolerance (P<.05 and P<.0005).
The researchers found that microalbuminuria levels related to creatinine were linked to fasting glucose levels (P=.0019), fasting insulin levels (P=.017) and insulin after 90 minutes (P=.027) and 120 minutes after glucose load (P=.023). They also found an indirect association to insulin sensitivity index composite (P<.0001). Multivariate analysis revealed log-insulin sensitivity index composite to be the strongest marker of microalbuminuria (P=.0021). – by Stacey L. Adams
J Clin Endocrinol Metab. 2008;93:710-714.
Comorbidities in acromegaly are major factors to consider in management of these patients. Studies have highlighted the importance of diabetes and cardiovascular disease as major contributors to the increased mortality seen with this disease. The increased recognition of these comorbidities has led to current guidelines stating the importance of normalizing hormone excess in such patients. This study reports microalbuminuria as a marker of endothelial dysfunction in acromegaly patients. Researchers found that patients with acromegaly and impaired glucose tolerance or diabetes have higher levels of microalbuminuria than those with normal glucose tolerance. This study provides an additional marker of cardiovascular risk in such patients and underscores the importance of normalizing hormone levels and impaired glucose tolerance in patients with acromegaly.
– Anne Klibanski, MD
Professor of Medicine, Harvard Medical School