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Keywords:

  • acromegaly;
  • growth hormone;
  • kidney;
  • klotho;
  • phosphate

Abstract.  Sze L, Bernays RL, Zwimpfer C, Wiesli P, Brändle M, Schmid C (Division of Endocrinology and Diabetes, University Hospital, Zurich; Division of Endocrinology and Diabetes, Kantonsspital, Gallen; Department of Neurosurgery, University Hospital, Zurich; and Department of Internal Medicine, Kantonsspital Frauenfeld, Frauenfeld, Switzerland). Excessively high soluble Klotho in patients with acromegaly. J Intern Med 2012; 272: 93–97.

Objectives.  Klotho-deficient mice develop a syndrome resembling accelerated ageing, and genetic variants of Klotho have been associated with human ageing. In humans, serum levels of soluble Klotho decrease with age and with chronic renal failure. The aim of our study was to examine the relationship between excess growth hormone (GH) and serum levels of Klotho in patients with acromegaly, a disease usually caused by a pituitary adenoma, which is associated with high phosphate levels and reduced life expectancy.

Patients and design.  We determined the levels of soluble Klotho, GH and insulin-like growth factor 1 (IGF-1) in serum samples from 24 consecutive patients with acromegaly (nine women/15 men, age 28–76 years) before and after transsphenoidal surgery.

Results.  Soluble Klotho levels were excessively high at baseline (mean ± SEM, 4.2 ± 0.7 ng mL−1) and correlated with GH (r = 0.64), IGF-1 (r = 0.57) and tumour size (r = 0.5). In multiple regression analysis, soluble Klotho was associated with GH after correction for age, gender and levels of creatinine and phosphate (= 0.029). After surgery, GH and IGF-1 levels decreased in all patients (from 26.3 ± 5.2 to 2.6 ± 0.6 μg L−1, P <0.0001, and from 588 ± 35 to 193 ± 12 μg L−1, < 0.001, 0.0001, respectively). Creatinine increased from 71 ± 3 to 80 ± 3 μmol L−1 (< 0.001), and phosphate decreased from 1.37 ± 0.04 to 1.06 ± 0.02 mmol L−1 (< 0.001). The markedly increased preoperative levels of soluble Klotho returned towards normal after surgery (0.7 ± 0.1 ng mL−1, < 0.0001).

Conclusions.  This is the first study to show dramatically increased soluble Klotho levels in an acquired disease in humans. Reversal following tumour removal suggests a causal relation between the GH-producing adenoma and high serum Klotho concentration in acromegaly.