Johns Hopkins Diabetes GuideComplications and ComorbiditiesEndocrine

Acromegaly

Nestoras Mathioudakis, M.D., Douglas Ball, M.D.
Acromegaly is a topic covered in the Johns Hopkins Diabetes Guide.

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DEFINITION

  • A clinical syndrome resulting from excessive secretion of growth hormone (GH).
  • GH excess prior to closure of the epiphyseal plates results in gigantism; after epiphyseal plate closure, the result is acromegaly.
  • Somatic and metabolic effects of chronic GH hypersecretion are predominantly mediated by high levels of insulin-like growth factor-1 (IGF-1).
  • Acromegaly is an uncommon secondary cause of diabetes.
  • Excess GH: 1) stimulates gluconeogenesis and lipolysis, causing hyperglycemia and elevated free fatty acid levels; 2) leads to both hepatic and peripheral insulin resistance, with compensatory hyperinsulinemia. Conversely, IGF-1 increases insulin sensitivity. However, in acromegaly, increased IGF-1 levels are unable to overcome the insulin-resistant state caused by GH excess.

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Last updated: June 14, 2011