Acromegaly is a rare endocrine disease caused by hypersecretion of growth hormone, most commonly arising due to a pituitary adenoma. Diabetes mellitus is a common complication of acromegaly, occurring in approximately one-third of patients. The risk of diabetes mellitus in acromegaly is driven by increased exposure to growth hormone, which directly attenuates insulin signalling and stimulates lipolysis, leading to decreased glucose uptake in peripheral tissues. Acromegaly is a unique human model, where insulin resistance occurs independently of obesity and is paradoxically associated with a lean phenotype and reduced body adipose tissue mass. Diabetes mellitus in patients with acromegaly is associated with an increased risk of cardiovascular morbidity and mortality. Therefore, preventive measures and optimized treatment of diabetes mellitus are essential in these patients. However, specific recommendations for the management of diabetes mellitus secondary to acromegaly are lacking due to limited research on this subject. This Review explores the underlying mechanisms for diabetes mellitus in acromegaly and its effect on morbidity and mortality. We also discuss treatment modalities for diabetes mellitus that are suited for patients with acromegaly. Improved understanding of these issues will lead to better management of acromegaly and its associated metabolic complications.

肢端肥大症是一种罕见的内分泌疾病，由生长激素分泌过多引起，最常见的是由垂体腺瘤引起。糖尿病是肢端肥大症的常见并发症，约三分之一的患者发生糖尿病。肢端肥大症患者患糖尿病的风险是由生长激素暴露增加所驱动的，生长激素直接减弱胰岛素信号并刺激脂肪分解，导致外周组织葡萄糖摄取减少。肢端肥大症是一种独特的人类模型，其中胰岛素抵抗的发生与肥胖无关，并且与瘦表型和身体脂肪组织量减少相关。肢端肥大症患者的糖尿病与心血管发病和死亡风险增加相关。因此，糖尿病的预防措施和优化治疗对于这些患者至关重要。然而，由于肢端肥大症继发糖尿病的研究有限，缺乏具体的治疗建议。本综述探讨了糖尿病肢端肥大症的潜在机制及其对发病率和死亡率的影响。我们还讨论了适合肢端肥大症患者的糖尿病治疗方式。对这些问题的进一步了解将有助于更好地治疗肢端肥大症及其相关的代谢并发症。