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Body Composition Changes with Long-term Pegvisomant Therapy of Acromegaly
CONTEXT: In active acromegaly, the lipolytic and insulin antagonistic effects of growth hormone (GH) excess alter adipose tissue (AT) deposition, reduce body fat, and increase insulin resistance. This pattern reverses with surgical therapy. Pegvisomant treats acromegaly by blocking GH receptor (GHR)...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Oxford University Press
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7853172/ https://www.ncbi.nlm.nih.gov/pubmed/33553983 http://dx.doi.org/10.1210/jendso/bvab004 |
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author | Kuker, Adriana P Shen, Wei Jin, Zhezhen Singh, Simran Chen, Jun Bruce, Jeffrey N Freda, Pamela U |
author_facet | Kuker, Adriana P Shen, Wei Jin, Zhezhen Singh, Simran Chen, Jun Bruce, Jeffrey N Freda, Pamela U |
author_sort | Kuker, Adriana P |
collection | PubMed |
description | CONTEXT: In active acromegaly, the lipolytic and insulin antagonistic effects of growth hormone (GH) excess alter adipose tissue (AT) deposition, reduce body fat, and increase insulin resistance. This pattern reverses with surgical therapy. Pegvisomant treats acromegaly by blocking GH receptor (GHR) signal transduction and lowering insulin-like growth factor 1 (IGF-1) levels. The long-term effects of GHR antagonist treatment of acromegaly on body composition have not been studied. METHODS: We prospectively studied 21 patients with active acromegaly who were starting pegvisomant. Body composition was examined by whole body magnetic resonance imaging, proton magnetic resonance spectroscopy of liver and muscle and dual-energy x-ray absorptiometry, and endocrine and metabolic markers were measured before and serially during 1.0 to 13.4 years of pegvisomant therapy. The data of patients with acromegaly were compared with predicted and to matched controls. RESULTS: Mass of visceral AT (VAT) increased to a peak of 187% (1.56-229%) (P < .001) and subcutaneous AT (SAT) to 109% (–17% to 57%) (P = .04) of baseline. These remained persistently and stably increased, but did not differ from predicted during long-term pegvisomant therapy. Intrahepatic lipid rose from 1.75% to 3.04 % (P = .04). Although lean tissue mass decreased significantly, skeletal muscle (SM) did not change. IGF-1 levels normalized, and homeostasis model assessment insulin resistance and HbA1C were lowered. CONCLUSION: Long-term pegvisomant therapy is accompanied by increases in VAT and SAT mass that do not differ from predicted, stable SM mass and improvements in glucose metabolism. Long-term pegvisomant therapy does not produce a GH deficiency-like pattern of body composition change. |
format | Online Article Text |
id | pubmed-7853172 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Oxford University Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-78531722021-02-04 Body Composition Changes with Long-term Pegvisomant Therapy of Acromegaly Kuker, Adriana P Shen, Wei Jin, Zhezhen Singh, Simran Chen, Jun Bruce, Jeffrey N Freda, Pamela U J Endocr Soc Clinical Research Articles CONTEXT: In active acromegaly, the lipolytic and insulin antagonistic effects of growth hormone (GH) excess alter adipose tissue (AT) deposition, reduce body fat, and increase insulin resistance. This pattern reverses with surgical therapy. Pegvisomant treats acromegaly by blocking GH receptor (GHR) signal transduction and lowering insulin-like growth factor 1 (IGF-1) levels. The long-term effects of GHR antagonist treatment of acromegaly on body composition have not been studied. METHODS: We prospectively studied 21 patients with active acromegaly who were starting pegvisomant. Body composition was examined by whole body magnetic resonance imaging, proton magnetic resonance spectroscopy of liver and muscle and dual-energy x-ray absorptiometry, and endocrine and metabolic markers were measured before and serially during 1.0 to 13.4 years of pegvisomant therapy. The data of patients with acromegaly were compared with predicted and to matched controls. RESULTS: Mass of visceral AT (VAT) increased to a peak of 187% (1.56-229%) (P < .001) and subcutaneous AT (SAT) to 109% (–17% to 57%) (P = .04) of baseline. These remained persistently and stably increased, but did not differ from predicted during long-term pegvisomant therapy. Intrahepatic lipid rose from 1.75% to 3.04 % (P = .04). Although lean tissue mass decreased significantly, skeletal muscle (SM) did not change. IGF-1 levels normalized, and homeostasis model assessment insulin resistance and HbA1C were lowered. CONCLUSION: Long-term pegvisomant therapy is accompanied by increases in VAT and SAT mass that do not differ from predicted, stable SM mass and improvements in glucose metabolism. Long-term pegvisomant therapy does not produce a GH deficiency-like pattern of body composition change. Oxford University Press 2021-02-01 /pmc/articles/PMC7853172/ /pubmed/33553983 http://dx.doi.org/10.1210/jendso/bvab004 Text en © The Author(s) 2021. Published by Oxford University Press on behalf of the Endocrine Society. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/ (https://creativecommons.org/licenses/by-nc-nd/4.0/) ), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com |
spellingShingle | Clinical Research Articles Kuker, Adriana P Shen, Wei Jin, Zhezhen Singh, Simran Chen, Jun Bruce, Jeffrey N Freda, Pamela U Body Composition Changes with Long-term Pegvisomant Therapy of Acromegaly |
title | Body Composition Changes with Long-term Pegvisomant Therapy of Acromegaly |
title_full | Body Composition Changes with Long-term Pegvisomant Therapy of Acromegaly |
title_fullStr | Body Composition Changes with Long-term Pegvisomant Therapy of Acromegaly |
title_full_unstemmed | Body Composition Changes with Long-term Pegvisomant Therapy of Acromegaly |
title_short | Body Composition Changes with Long-term Pegvisomant Therapy of Acromegaly |
title_sort | body composition changes with long-term pegvisomant therapy of acromegaly |
topic | Clinical Research Articles |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7853172/ https://www.ncbi.nlm.nih.gov/pubmed/33553983 http://dx.doi.org/10.1210/jendso/bvab004 |
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