Practical therapeutic approach in the management of diabetes mellitus secondary to Cushing's syndrome, acromegaly and neuroendocrine tumours

Valentina Guarnotta; Fabrizio Emanuele; Riccardo Salzillo; Maria Bonsangue; Carlotta Amato; Mariagrazia Irene Mineo; Carla Giordano

doi:10.3389/fendo.2023.1248985

Practical therapeutic approach in the management of diabetes mellitus secondary to Cushing's syndrome, acromegaly and neuroendocrine tumours

Front Endocrinol (Lausanne). 2023 Sep 28:14:1248985. doi: 10.3389/fendo.2023.1248985. eCollection 2023.

Authors

Valentina Guarnotta¹, Fabrizio Emanuele¹, Riccardo Salzillo¹, Maria Bonsangue¹, Carlotta Amato¹, Mariagrazia Irene Mineo¹, Carla Giordano¹

Affiliation

¹ Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Section of Endocrinology, University of Palermo, Piazza delle Cliniche 2, Palermo, Italy.

Abstract

Cushing's syndrome, acromegaly and neuroendocrine disorders are characterized by an excess of counterregulatory hormones, able to induce insulin resistance and glucose metabolism disorders at variable degrees and requiring immediate treatment, until patients are ready to undergo surgery. This review focuses on the management of diabetes mellitus in endocrine disorders related to an excess of counterregulatory hormones. Currently, the landscape of approved agents for treatment of diabetes is dynamic and is mainly patient-centred and not glycaemia-centred. In addition, personalized medicine is more and more required to provide a precise approach to the patient's disease. For this reason, we aimed to define a practical therapeutic algorithm for management of diabetes mellitus in patients with glucagonoma, pheochromocytoma, Cushing's syndrome and acromegaly, based on our practical experience and on the physiopathology of the specific endocrine disease taken into account. This document is addressed to all specialists who approach patients with diabetes mellitus secondary to endocrine disorders characterized by an excess of counterregulatory hormones, in order to take better care of these patients. Care and control of diabetes mellitus should be one of the primary goals in patients with an excess of counterregulatory hormones requiring immediate and aggressive treatment.

Keywords: GH secreting; catecholamine; cortisol; counterregulatory hormones; glucagonoma; pheochromocytoma.

Publication types

Review

MeSH terms

Acromegaly* / complications
Acromegaly* / therapy
Cushing Syndrome* / complications
Cushing Syndrome* / therapy
Diabetes Mellitus* / drug therapy
Diabetes Mellitus* / therapy
Hormones / therapeutic use
Humans
Neuroendocrine Tumors* / complications
Neuroendocrine Tumors* / therapy

Substances

Hormones

Grants and funding

This review did not receive external funding. This research was funded by FFR2021 of the University of Palermo assigned to Carla Giordano and Valentina Guarnotta.