Rosiglitazone Therapy of Diabetes Mellitus in Acromegaly Causes Significant Reduction of Growth Hormone and Insulin-like Growth Hormone I Secretion

摘要

Pituitary tumors account for approximately 15% of intra-cranial tumors. They are common generally benign monoclonal neoplasms and rarely metastasize but often invade surrounding pituitary structures, leading to local compressive effects and hormonal hyposecretion or hypersecretion. When this occurs, total surgical excision is difficult and treatment-associated endocrine deficiency a frequent outcome. Some pituitary tumors secrete hormones such as prolactin and growth hormone, and in most of these PRL- and GH-secret-ing pituitary tumors, dopamine agonists and/or somatostatin analogues effectively suppress PRL and GH hypersecretion. Tumor growth is often controlled, and tumor shrinkage is reported. A subset of patients with PRL- and GH-secreting pituitary tumors does not respond to or is intolerant of these drugs. Pituitary microsurgery is the usual therapy for first choice but is not always successful in achieving remission. It is also associated with a significant incidence of late recurrence. Excess GH concentrations lead to insulin resistance in 80% of patients with acromegaly. Impaired glucose tolerance occurs in 40% and diabetes mellitus in 10%-20% of these patients. Complete resolution of diabetes mellitus occurs in two thirds of patients with successful surgery.