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Front. Endocrinol. | doi: 10.3389/fendo.2019.00509

Insulin resistance in patients with acromegaly

 Greisa Vila1, Jens Otto L. Jørgensen2,  Anton Luger1 and Günter K. Stalla3*
  • 1Department of Internal Medicine III, Medical University of Vienna, Austria
  • 2Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Denmark
  • 3Max Planck Institute of Psychiatry (MPI), Germany

Acromegaly is characterized by chronic overproduction of growth hormone (GH) that leads to insulin resistance, glucose intolerance and, ultimately, diabetes. The GH-induced sustained stimulation of lipolysis plays a major role not only in the development of insulin resistance and prediabetes/diabetes, but also in the reduction of lipid accumulation, making acromegaly a unique case of severe insulin resistance in the presence of reduced body fat. In the present review, we elucidate the effects of GH hypersecretion on metabolic organs, describing the pathophysiology of impaired glucose tolerance in acromegaly, as well as the impact of acromegaly-specific therapies on glucose metabolism. In addition, we highlight the role of insulin resistance in the development of acromegaly-associated complications such as hypertension, cardiac disease, sleep apnea, polycystic ovaries, bone disease and cancer. Taken together, insulin resistance is an important metabolic hallmark of acromegaly, which is strongly related to disease activity, the development of comorbidities, and might even impact the response to drugs used in the treatment of acromegaly.

Keywords: Glucose, Insulin, Growth Hormone, Insulin-like growth factor I (IGF-I), Acromegaly, complications, Insulin Resistance, diabetes, comorbidities, pathophysiology

Received: 05 May 2019; Accepted: 12 Jul 2019.

Edited by:

Marek Bolanowski, Wroclaw Medical University, Poland

Reviewed by:

Odelia Cooper, Cedars-Sinai Medical Center, United States
Marija Pfeifer, Faculty of Medicine, University of Ljubljana, Slovenia  

Copyright: © 2019 Vila, Jørgensen, Luger and Stalla. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Prof. Günter K. Stalla, Max Planck Institute of Psychiatry (MPI), Munich, 80804, Bavaria, Germany,