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J. Clin. Endocrinol. Metab. · Aug 2015
Clinical TrialAdipose Tissue Redistribution and Ectopic Lipid Deposition in Active Acromegaly and Effects of Surgical Treatment.
- Carlos M Reyes-Vidal, Hamed Mojahed, Wei Shen, Zhezhen Jin, Fernando Arias-Mendoza, Jean Carlos Fernandez, Dympna Gallagher, Jeffrey N Bruce, Kalmon D Post, and Pamela U Freda.
- Departments of Medicine (C.M.R.-V., W.S., J.C.F., D.G., P.U.F.), Radiology (H.M., F.A.-M.), Biostatistics (Z.J.), and Neurosurgery (J.N.B.), Columbia University, College of Physicians & Surgeons, New York, New York 10032; and Departments of Medicine and Neurosurgery (K.D.P.), Mt. Sinai School of Medicine, New York, New York 10029.
- J. Clin. Endocrinol. Metab. 2015 Aug 1;100(8):2946-55.
ContextGH and IGF-I have important roles in the maintenance of substrate metabolism and body composition. However, when in excess in acromegaly, the lipolytic and insulin antagonistic effects of GH may alter adipose tissue (AT) deposition.ObjectivesThe purpose of this study was to examine the effect of surgery for acromegaly on AT distribution and ectopic lipid deposition in liver and muscle.DesignThis was a prospective study before and up to 2 years after pituitary surgery.SettingThe setting was an academic pituitary center.PatientsParticipants were 23 patients with newly diagnosed, untreated acromegaly.Main Outcome MeasuresWe determined visceral (VAT), subcutaneous (SAT), and intermuscular adipose tissue (IMAT), and skeletal muscle compartments by total-body magnetic resonance imaging, intrahepatic and intramyocellular lipid by proton magnetic resonance spectroscopy, and serum endocrine, metabolic, and cardiovascular risk markers.ResultsVAT and SAT masses were lower than predicted in active acromegaly, but increased after surgery in male and female subjects along with lowering of GH, IGF-I, and insulin resistance. VAT and SAT increased to a greater extent in men than in women. Skeletal muscle mass decreased in men. IMAT was higher in active acromegaly and decreased in women after surgery. Intrahepatic lipid increased, but intramyocellular lipid did not change after surgery.ConclusionsAcromegaly may present a unique type of lipodystrophy characterized by reduced storage of AT in central depots and a shift of excess lipid to IMAT. After surgery, this pattern partially reverses, but differentially in men and women. These findings have implications for understanding the role of GH in body composition and metabolic risk in acromegaly and other clinical settings of GH use.
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