Acromegalia: Metabolismo da Glicose Como Possível Preditor de Tumores Mais Agressivos

Abstract

Introduction: Acromegaly is a disorder with excess growth hormone (GH) secretion. In the majority of cases, there is a pituitary adenoma responsible for this hypersecretion. It is also associated with the presence of several comorbidities, such as arterial hypertension (HT) and type 2 diabetes mellitus (DM2). However, the association between these comorbidities at diagnosis and the presence of a more aggressive growth hormone-secreting tumor remains to be elucidated. Aim: To determine if comorbidities at diagnosis are predictors to a more aggressive tumor in patients with acromegaly. Methods: Patients diagnosed with acromegaly in our center between January 2008 and November 2020 and with a follow-up period of at least 12 months were included. Patients without data regarding the age at diagnosis, tumor characteristics, clinical or biochemical parameters evaluated at presentation were excluded. We considered the clinical and biochemical predictors of a more aggressive tumor at diagnosis as the primary outcome. Results: Seventy-three patients with acromegaly were included and 63% were females. The mean age at diagnosis was 50.3 ± 15.2 years old and only 1 patient had family history suggestive of familial pituitary adenoma (FIPA). At first evaluation, mean HbA1c levels were 6.6 ± 1.2 % and LDL cholesterol 112.1 ± 31.3 mg/dL, 65.3% of patients presented with a macroadenoma, 38.9% of the tumors had extrasellar extension and 18.1% of were locally invasive. Our results showed a positive association between levels of blood glucose and IGF-1 at diagnosis and the presence of an invasive tumor (OR=1.015, p=0.018; OR=1.002, p=0.009, respectively). There was also a positive correlation between levels of GH and maximum tumor diameter (=0.037, p=0.019). Furthermore, we highlighted a negative correlation between tumor maximum diameter at diagnosis and levels of total cholesterol (=-0.80; p=0.017) and LDL cholesterol (=-0.096, p=0.024) at one-year follow-up. Conclusion: Higher levels of blood glucose may be associated with a more aggressive tumor at diagnosis, specifically higher prevalence of more invasive adenomas, in patients with acromegaly.