Prolaktinoma ve Akromegali Hastalarının Takibinde Nonalkolik Yağlı Karaciğer Hastalığı, Sarkopeni ve Serum Angiopoietin-like Protein-8 Düzeyinin Değerlendirilmesi

Abstract

Eroğlu İ. Evaluation of Nonalcoholic Fatty Liver Disease, Sarcopenia and Serum Angiopoietin-like Protein-8 Levels in the Follow-up of Patients with Prolactinoma and Acromegaly, Hacettepe University Faculty of Medicine, Thesis in Internal Medicine, Ankara, 2022. Acromegaly and prolactinoma are endocrinological disorders that also have effects on the musculoskeletal system and metabolism. Many endocrinological diseases are involved in the etiology of nonalcoholic fatty liver disease (NAFLD), which is considered the hepatic component of the metabolic syndrome. Serum angiopoietin-like protein-8 (ANGPTL-8) levels were found to be higher in NAFLD patients. In this study, the relationship between NAFLD, osteosarcopenia and ANGPTL-8 levels in patients with acromegaly and prolactinoma was investigated. The study included 32 patients with acromegaly (15 with active and 17 with controlled disease), 12 patients with active prolactinoma, and 18 patients with diagnosis of NAFLD. The study also involved eight healthy controls for the NAFLD group, 12 healthy controls for the prolactinoma group, and 19 healthy controls for the acromegaly group. A new group called “reference group (n: 57)” was formed with patients with NAFLD diagnosis and individuals in the healthy control groups. Patients with prolactinoma and acromegaly were compared to their own control groups as well as the reference group. All participants were evaluated with anthropometric, biochemical and hormonal measurements, magnetic resonance imaging (MRI) of the abdomen and whole body dual energy X-ray absorptiometry (DXA). Serum ANGPTL-8 levels and muscular strength of all participants were also measured. Although HbA1c, spot urine albumin/creatinine ratio and triglyceride level were significantly higher in the acromegaly group than in the control group (p=0.001, p=0.041 and p=0.017, respectively) and the HOMA-IR value tended to be higher (p<0.1), liver fat ratio and NAFLD prevalence were similar between the groups. In the subgroup analysis, it was observed that the liver fat ratio and NAFLD prevalence in active acromegaly patients were significantly lower than in the controlled acromegaly patients (p<0.026 and p<0.001, respectively) and tended to be lower than the control group (p<0.1). Liver fat ratio and NAFLD prevalence were similar between prolactinoma patients and control group. Growth hormone levels were found to be significantly lower in individuals diagnosed with NAFLD in all three of the acromegaly, prolactinoma and reference groups (p=0.025, p=0.047 and p=0.015, respectively). No difference was observed between serum ANGPTL-8 levels of individuals with and without NAFLD diagnosis in the prolactinoma and reference group. In the acromegaly group, the serum ANGPTL-8 level was found to be lower in patients diagnosed with NAFLD compared to individuals not diagnosed with NAFLD (p=0.036). The acromegaly group had a significantly higher vertebral fat ratio than the reference and control groups (p<0.001 and p=0.09, respectively). In the subgroup analysis, it was determined that the vertebral fat ratio was higher in patients with controlled acromegaly than in patients with active acromegaly and in the control group (p=0.04 and p=0.001, respectively). Vertebral fat ratio tended to be higher in the prolactinoma group than in the control group (p<0.1). When acromegaly and prolactinoma patients were compared with their control groups, hand grip strength and muscle mass measured by DXA and MRI were found to be similar. The ratio of hand grip strength/appendicular skeletal muscle (HGS/ASM), which is used as a measure of muscle quality, was lower in the acromegaly group than in the control group (p=0.017). The number of individuals with low/weak muscle quality according to the HGS/ASM ratio was higher in patients with acromegaly than in controls (p=0.006). The ratio of HGS/ASM in prolactinoma patients tended to be higher than in the control group (p<0.1). In this study, it was observed that high growth hormone levels may be protective against the risk of NAFLD in patients with active acromegaly, and ANGPTL-8 levels were lower in patients with acromegaly with fatty liver. It was concluded that while there was a decrease in muscle quality in patients with acromegaly and there was a tendency to increase in muscle quality in patients with prolactinoma.