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￭ Sat-285 ￭
Adjuvant therapy in Acromegaly: Clinical course and factors predicting biochemical controls
1연세대학교 의과대학 내과학교실 내분비내과, 2연세대학교 의과대학 신경외과학교실
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정혜인
1, 구철룡
1, 김다함
1, 문주형
2, 김의현
2, 김선호
2, 이은직
1Background/Aims: Although surgical resection is the 1st line therapy for acromegaly, many patients do not achieve biochemical remission after surgery and require the adjuvant therapy including medical treatment (somatostatin analogues; SSA, and dopamine agonist), conventional radiotherapy, and gam- ma-knife surgery (GKS). Due to the limitations of rare disease, there are few studies evaluating the efficacy of each adjuvant treatment. In this study, we in- vestigated clinical course and disease control after initiation of adjuvant treatment. Methods: We performed a single-center retrospective study including acromegalic patients treated with SSA at least for 6 months, between from January 1, 2005 to June 30, 2018. Age, gender, GH, IGF-1 levels, fasting free fatty acids, glucose, and tumor size were measured before/after operation, medical treatments, or radiotherapy. The patients were considered con- trolled/cured if fasting mean GH levels were less than 2.5ng/ml or nadir GH after oral glucose loading was less than 1 ng/ml. Results: We analyzed 72 pa- tients for median 62.9 months (40.0-111.5). The median age was 46 (37-53) years. The median duration of SSA use was 31.5 months (12.6-53.0). The me- dian GH level was 30.5 (17.6-47.3) ng/ml, IGF-1 was 694.7 (600.0-862.8) ng/ml, initial tumor size was 24 (17.2-32.2) mm. Of 72 patients, 13 patients (18%) underwent surgical resection and 40 patients (55.6%) underwent GKS. Of the 40 patients who underwent GKS, 16 (40%) discontinued the medi- cation after 26 months. After treatment, 54 patients (75%) were biochemically controlled. Before initiation of SSA treatment, biochemically controlled group had lower GH (3.63 vs 15.35ng/ml, p<0.001), IGF-1 (514.0 vs 641.9ng/ml, p=0.005), nadir GH after oral glucose loading (2.66 vs 7.9ng/ml, p<0.001) and basal glucose level (94.5 vs 104.5g/ml, p=0.098) than non-controlled group. Among the enrolled patients, 34 subjects (52.3%) had a size re- duction of more than 10%. Conclusions: In conclusion, basal GH level and presence of visible remnant tumor was correlated with biochemical response after adjuvant treatment. Appropriate adjuvant treatment should be decided according to the disease status of acromegalic patients.
￭ Sat-286 ￭
Diabetes Peripheral Neuropathy and Carotid Atherosclerosis in Type 2 Diabetic Subjects
가톨릭대학교 의정부성모병원 내과
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이한비, 남궁지수, 신상오, 신승호, 손태서
Background/Aims: Diabetic peripheral neuropathy (DPN) is the most prevalent chronic complications of diabetes with high mortality rates and carotid intima-media thickness (CIMT) has been shown to predict cardiovascular risk. However, little is known about the association between DPN and athero- sclerotic vascular changes. The aim of this study is to investigate the association between DPN and CIMT in type 2 diabetic subjects. Methods: Peripheral neuropathy and CIMT were measured in a cross-sectional sample of 114 patients with T2DM Results: The present study included 114 subjects with T2DM (age 57.4 ± 8.0, diabetes duration 9.2 ± 6.4 years, HbA1c 7.5 ± 1.6%, eGFR 79.3 ± 1.6 ml/min/1.73 m2). DPN status was ascertained using the Michigan Neuropathy Screening Instrument clinical examination (MNSIE). MNSIE score ≥ 2.5 defined the presence of DPN. CIMT was measured using high-reso- lution B-mode ultrasonography and the maximal CIMT value was measured. Of the 114 subjects, 44 (39%) had DPN. Subjects with and without DSP had similar age (58.0 ±8.5 vs 57.0 ± 7.8 years), diabetes duration (10.8 ± 7.4 vs 8.2 ± 5.6 years), body mass index (24.8 ± 3.1 vs 24.6 ± 3.2 kg/m2), eGFR (76.3
± 15.4 vs 81.3 ± 12.8 ml/min/1.73 m2), and not poor glycemic control (7.8 ± 1.5 vs 7.4 ± 1.6%). However, subjects with DPN had higher CIMT than those without DPN (1.80 ± 0.92 vs 1.31 ± 0.52 mm, P=0.048). Linear regression analysis showed that CIMT was associated with MNSIE score (R2=0.1126, P=0.016). Conclusions: In asymptomatic type 2 diabetic subjects, CIMT is significantly associated with MNSIE score. Subjects with DPN are at high risk of cardiovascular disease and careful assessment of the combined risks and intensive interventions are needed.
