Table 3: Practical considerations for the management of glycaemic parameters in pituitary hypersecretory states.

Screen for DM by measuring FPG, OGTT or HbA1c in acromegaly, Cushing’s disease and TSH-secreting pituitary adenoma

First generation SSA is the first-line therapy for acromegaly with persistent disease despite surgical resection

Pegvisomant should be the preferred switch-over agent in patients not optimally controlled on first-generation SSAs, in the presence of pre-existing clinically relevant impaired glucose metabolism

First-generation SSAs increase HbA1c by causing postprandial hyperglycaemia; appropriate adjustment in glucose-lowering treatment is recommended

Second-generation SSAs, like pasireotide, worsen glycaemic status; treatment with incretin-based or other glucose-lowering therapy to be considered. In case of severe hyperglycaemia, switch over to pegvisomant is recommended

For Cushing’s disease not cured by surgical treatment, use of pasireotide can worsen glucose metabolism; incretin-based or other glucose-lowering therapy to be considered

Treatment with mifepristone can improve hyperglycaemia in Cushing’s syndrome

DM = diabetes mellitus; FPG = fasting plasma glucose; HbA1c = glycated haemoglobin; OGTT = oral glucose tolerance test; SSA = somatostatin analogue; TSH = thyroid-stimulating hormone.