Possible protective role of metformin therapy on colonic polyps in acromegaly: an exploratory cross-sectional study

in European Journal of Endocrinology
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  • 1 Endocrinology Unit, IRCCS AOU San Martino, Genoa, Italy
  • 2 Endocrinology Unit, Department of Internal Medicine and Medical Specialties (DIMI) and Centre of Excellence for Biomedical Research (CEBR), University of Genoa, Genoa, Italy
  • 3 Endocrinology and Diabetology, ASL2 Savonese, Liguria, Italy
  • 4 Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, Naples, Italy
  • 5 Medical Oncology Unit 1, IRCCS AOU San Martino, Genoa, Italy
  • 6 UNESCO Chair for Health Education and Sustainable Development, Federico II University, Naples, Italy
  • 7 SC Diabetology and Metabolic Disease, ASL 3 Genovese, Liguria, Italy

Correspondence should be addressed to M Albertelli; Email: manuela.albertelli@unige.it

*(M Albertelli and E Nazzari contributed equally to this work)

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Context

Colonic polyps occur in 30–40% of acromegalic patients, increasing the risk of colon carcinoma. Although debated, there is emerging evidence that metformin may play a protective role in diabetic and non-diabetic patients with colonic polyps and its use in chemoprevention is currently explored.

Objective

Evaluate the prevalence of colonic polyps in acromegalic patients treated or not with metformin and explore its possible protective role.

Design

Exploratory cross-sectional study in two tertiary Italian referral centres.

Met

hods: Out of 153 acromegalic patients, we selected 58 patients (36–82 years; f: 33) who had at least one colonoscopy performed within the first 2 years of diagnosis. Presence of colonic polyps/cancer and related risk factors, current metformin and acetylsalicylic acid intake, disease duration, therapies for acromegaly, hormonal and metabolic parameters were assessed.

Results

An overall prevalence of 36% polyps was found. Based on the presence of polyps, we identified two groups, comparable for age, BMI, disease duration, glucose, insulin, HOMA-IR, HbA1c, GH and IGF-I levels. Of the patients with polyps (including three adenocarcinomas) only 24% were treated with metformin vs 57% of patients without polyps. Multivariate analysis confirmed a significant negative association between colonic polyps and metformin intake (OR: 0.22, 95% CI: 0.06-0.77, P = 0.01), whereas no significant association was found between polyps and age (P = 0.10), overweight/obesity (P = 0.54), smoking (P = 0.15), acetylsalicylic acid intake (P = 0.99), disease duration (P = 0.96), somatostatin analogues treatment (P = 0.70).

Conclusions

These findings, though deriving from an exploratory study, could suggest a protective role of metformin on the development of colonic polyps in acromegaly, and need to be confirmed in an extended study population.

 

     European Society of Endocrinology

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