Postoperative Changes in Metabolic Parameters of Patients with Surgically Controlled Acromegaly: Assessment of New Stringent Cure Criteria

Abstract

The criteria for surgical cure of acromegaly have become more stringent during the past decades and a change from Cortina to new consensus criteria has recently been proposed. However, the superiority of the new consensus over Cortina criteria with respect to postoperative metabolic parameters remains to be ascertained. We retrospectively assessed metabolic parameters, the body habitus, and other health-related parameters of 48 patients with surgically controlled acromegaly who met the Cortina criteria [normalized insulin-like growth factor-1 (IGF-1) level and nadir growth hormone (GH) level <1.0 ng/ml during postoperative oral glucose tolerance test]. The 48 patients were divided into two groups. Group A (n = 33) met the new consensus criteria (normalized IGF-1 and nadir GH level <0.4 ng/ml). Group B (n = 15) met Cortina criteria, but their nadir GH ranged from 0.4 to 1.0 ng/ml. In both groups, the level of triglyceride and homeostasis model assessment-insulin resistance (HOMA-IR) was significantly decreased 1 year after the operation (P < 0.05). High-density lipoprotein cholesterol showed a significant increase only in group B (P = 0.02). However, the two groups did not differ with respect to the postoperative improvement rate of these parameters and the other health-related parameters including body mass index, blood pressure, anterior pituitary function, and self-estimated quality of life scale. In conclusion, our findings show that with respect to changes in metabolic parameters and the body habitus assessed 1 year after surgery, the stricter consensus criteria seemed not to be superior to Cortina criteria.

Keywords: Cortina criteria; acromegaly; metabolic parameters; new consensus criteria; surgical cure.

Fig. 1.

Rate of improvement in metabolic parameters in all (n = 48), group A (n = 33), and group B patients (n = 15). There was no significant difference between groups A and B. The LDL improvement rate tended to be higher in group B than group A (P = 0.08, Student t-test). BMI: body mass index, HDL: high-density lipoprotein, HOMA-IR: homeostasis model assessment-insulin resistance, LDL: low-density lipoprotein, T-chol: total cholesterol, TG: triglyceride.

Fig. 2.

Postoperative changes in the blood pressure of all (n = 48), group A (n = 33), and group B patients (n = 15). The systolic and diastolic pressure was reduced significantly in both groups (P < 0.03, paired t-test). There was no difference in the improvement rate of the two groups.