Группа авторов

Metabolic Syndrome Consequent to Endocrine Disorders


Скачать книгу

is more complex. First generation somatostatin analogues (SSA) like octreotide and lanreotide compromise beta cell function and decrease insulin and glucagon secretion since they are preferentially subtype-2 somatostatin receptor ligands [30]. However, these medications significantly improve insulin sensitivity by virtue of decreasing GH and IGF-1 levels so their net effect is usually an improvement in glucose metabolism [31, 32]. Pasireotide is a second-generation SA that targets not only subtype-2 somatostatin receptor, but also SSTR1, SSTR3 and SSTR5 with considerable affinity and is somewhat more effective than octreotide and lanreotide in normalizing GH and IGF-1 levels [33, 34]. This new SSA results in fasting hyperglycemia in over 50% of patients [34, 35]. Pasireotide-induced hyperglycemia results from its interaction with pancreatic SSTR5 which results in both a greater compromise of insulin secretion as well as an inhibition of incretin secretion [36], (Fig. 1).

Img

      Changes in Lipid Metabolism

      Other Cardiometabolic Risk Factors in Acromegaly

      Active acromegaly presents a unique combination of features associated with an increased cardiovascular risk. Despite having a striking reduction in insulin sensitivity, patients with acromegaly have lower total and trunk fat mass and higher lean body mass. Both, the traditional and the emergent biomarkers of cardiovascular risk behave somewhat differently in active acromegalic patients as compared to the general population.