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Influence of disease control with pegvisomant on sleep apnoea and tongue volume in patients with active acromegaly

¹ Division of Laboratory Research, Department of Endocrinology² Department of Respiratory and Sleep Medicine, Ruhrlandklinik³ , Department of Radiology⁴ Department of Oral and Maxillofacial Surgery, University of Duisburg-Essen, Hufelandstraße 55, D-45122 Essen, Germany⁵ Division of Endocrinology and Diabetology, Technology Center Bochum, 44799 Bochum, Germany

(Correspondence should be addressed to C Berg; Email: christian.berg{at}uni-essen.de)

Objectives: Sleep apnoea has been consistently reported to occur in acromegaly. In uncontrolled patients, the severity of sleep apnoea influences physical activity in the daytime. We investigated the influence of disease activity on tongue volume and sleep apnoea treated with the GH receptor antagonist pegvisomant in poorly controlled patients with acromegaly under octreotide.

Design and methods: A total of 12 patients with active acromegaly (six females; six males; mean age 57±15 years; body mass index 29.4±4.2 kg/m²; mean±S.D.) were treated with pegvisomant (13.5±5.0 mg/die) for 6 months. Tongue volume was examined by magnetic resonance imaging, and sleep apnoea was characterized by polysomnography before and after 6 months of treatment with pegvisomant. The mandibular length was determined by lateral X-ray films.

Results: IGF1 levels decreased after 6 months in all patients (407±114 to 199±23 µg/l; P=0.0001). The tongue volume decreased (105±33 to 83±33 ml; P=0.007) as well as the apnoea–hypnoea index (23±22 to 18±18/h; P=0.0066). The mandibular length correlated with the initial tongue volume (r²=0.6072, P=0.0028).

Conclusion: In conclusion, successful treatment with pegvisomant can decrease tongue volume, which has benefits for coexisting sleep disordered breathing.