A influência dos níveis séricos de IGF-1 no perfil lipídico e glicêmico de acromegálicos em um Centro de Especialidades Médicas no Pará

Abstract

Introduction: Acromegaly is an insidious and rare disease, associated with a high mortality rate, which results from the pathological autonomous overproduction of growth hormone (GH) and the subsequent increase in insulin-like growth factor-1 (IGF-1) levels. Chronic hypersecretion of these hormones causes several metabolic changes, among which we can highlight lipolysis, atherosclerotic processes, hyperinsulinemia, gluconeogenesis and peripheral insulin resistance. These changes in lipid and glycemic metabolism are related to an increased risk of cardiovascular events in acromegalic patients, being today the second most common cause of mortality in these patients. As a result, it is necessary to assess whether the control of the disease also corresponds to a better metabolic control of these patients, resulting in a lower cardiovascular risk and a lower mortality rate. Objectives: To evaluate the influence of IGF-1 levels on the lipid and glycemic profile of acromegalic patients treated at the Cesupa Medical Specialties Center. Methodology: This is an epidemiological, cross-sectional and descriptive study, based on an exploratory analysis of the medical records of the Endocrinology Service of the Cesupa Medical Specialties Center (CEMEC) from August 2019 to June 2020. Results: When comparing acromegaly activity in the first and last consultation, it was found that there was an increase in disease control, from 22.2% to 71.1%. As for the glycemic profile, the glycemia of diabetic acromegalic patients was statistically higher than that of non-diabetics, both in the first assessment (Mean ± SD: 135.8 ± 59.4 vs 95.1 ± 15.2; P <0.001), and in the latter (Mean ± SD: 98.6 ± 13.2 vs 84.0 ± 11.1; P <0.001). When observing diabetic acromegalic patients, there was a significant decrease in the levels of IGF-1 (mean ± SD: 480.9 ± 250.5 vs 189.5 ± 91.5, P <0.001) and IGF-1 by LSN ( mean ± SD: 1.8 ± 1.0 vs 1.0 ± 0.6, P <0.001), when comparing the two assessments. It was possible to observe, comparing the laboratory parameters between the first and last evaluation, that in the uncontrolled acromegaly at the end (n = 13), there was a decrease in the total cholesterol levels (Mean ± SD: 179.3 ± 30.0 vs 155, 9 ± 28.8; P = 0.018) and, significant increase in HDL (Mean ± SD: 46.8 ± 14.3 vs 53.3 ± 7.9; P = 0.048). For patients with controlled acromegaly at the end (n = 32), there was a significant increase in the HDL level (Mean ± SD: 46.3 ± 26.0 vs 58.0 ± 24.2; P = 0.003) and a decrease in levels of IGF-1, GH, total cholesterol, LDL and TG. Conclusion: These results suggest that most of the acromegalics under study had control of the disease by reducing the levels of IGF-1, evidencing success in their therapeutic conduct. Concomitantly, the majority also obtained improvement in the levels of glucose, glycated hemoglobin, total cholesterol and HDL. This suggests that controlling disease activity is one of the most important interventions for reducing cardiovascular risk in these patients.