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Gender dimorphism in body composition abnormalities in acromegaly: males are more affected than females

¹ Endocrinology Department and Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBER-ER, Unidad 747), ISCIII, 08025 Barcelona, Spain² Hospital Sant Pau, Autonomous University of Barcelona, Barcelona, Spain³ Endocrinology Department, Institut d'Investigació Biomèdica de Girona (IDIBGI) and CIBER Fisiopatología de la Obesidad y Nutrición CB06/03/010, Hospital Josep Trueta, Girona, Spain⁴ , Department of Internal Medicine⁵ Department of Epidemiology, Hospital Sant Pau, Autonomous University of Barcelona, Barcelona, Spain

(Correspondence should be addressed to N Sucunza who is now at Department of Endocrinology, Hospital Manacor, Carretera de Palma a Artà s/n, 07500 Manacor, Mallorca, Spain; Email: nsucunza{at}hmanacor.org)

Background: Acromegaly changes body composition (BC), but long-term gender differences have not been reported.

Objective: To evaluate BC in active and controlled acromegalic patients.

Design and methods: Clinical and biochemical variables and BC (by dual-energy X-ray absorptiometry) were evaluated in 60 acromegalic patients (19 active, 41 controlled) and 105 controls, matched for age and gender.

Results: Acromegalic males (n=24) had more total mass (89±13 vs 76.5±15.3 kg, P<0.001), lean body mass (LBM; 64.6±8.7 vs 56.4±5.8 kg, P<0.001), and bone mineral content (BMC; 2.9±0.5 vs 2.6±0.3 kg, P<0.05) than controls (n=33). Controlled male patients (n=14) had more total mass (89±14.7 vs 76.5±15.3 kg, P<0.05) and a trend to have more LBM (61.8±9.4 vs 56.4±5.8 kg, P=0.065) than controls. Only in active disease was a decrease in fat mass (FM) observed, compared with controlled patients and controls (males: 19.5±5.3 vs 27±6.2 and 25.9±4%, P<0.001; females: 30.3±6.7 vs 37.1±5.8 and 36.5±6.6%, P<0.01). In females, no further differences were observed. No differences in BMC were found between eugonadal and hypogonadal acromegalic patients, but in hypogonadal females, acromegaly appeared to prevent the BMC loss seen in hypogonadal postmenopausal controls. GH and IGF1 levels were negatively correlated with FM (males, P<0.05; females, P<0.001), but in the regression analysis GH was a predictor of FM only in women.

Conclusions: Control of acromegaly reverts decreased FM in both genders; only in males more total mass and a trend for more LBM persist. The anabolic effect of GH on bone reverted in cured males, but persisted in females and appeared to override the bone loss of menopause.