Prognostic value of nadir GH levels for long-term biochemical remission or recurrence in surgically treated acromegaly
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Prognostic value of nadir GH levels for long‑term biochemical remission or recurrence in surgically treated acromegaly Pamela U. Freda1 · Jeffrey N. Bruce2 · Carlos Reyes‑Vidal1 · Simran Singh1 · Yessica DeLeon4 · Zhezhen Jin5 · Alexander G. Khandji3 · Serge Cremers4 · Kalmon D. Post6 Accepted: 8 October 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Context Outcome of acromegaly surgery is assessed by IGF-1 and glucose-suppressed GH, but whether the latter provides additional clinically relevant information when IGF-1 is normal is unclear. The role of GH suppression testing after surgery requires clarification. Methods We studied 97 acromegaly patients with normal IGF-1 after surgery by measuring GH after oral glucose longitudinally, initially at ≥ 3 months after surgery and repeated one or more times ≥ 1 year later. Nadir GH was categorized as normal or abnormal relative to the 97.5th percentile of nadir GH in 100 healthy subjects, which were ≤ 0.14 µg/L (DSL IRMA) or ≤ 0.15 µg/L(IDS iSYS). Signs and symptoms scores and insulin resistance were followed longitudinally. Results Of 68 patients with initial normal GH suppression 63 (93%) remained in remission and of 29 with initial abnormal GH suppression, 9 (31%) recurred. Recurrence was more common in patients with abnormal suppression (P 2 µg/L using an RIA and > 1 µg/L with a modern IRMA or chemiluminescent assay). All had transsphenoidal surgery and pathological confirmation of a pituitary tumor positive for GH on immunohistochemical (IHC) staining. For the current study, we screened the cohort for patients meeting the following criteria: (1) normalization of IGF-1 level (for at least 15 months) after
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surgery as the only therapy, (2) GH levels measured by 1 of 2 sensitive, specific assays (see methods) during at least 2 OGTTs, the first (initial) being perfomed ≥ 3 months after surgery and the second at least 1 year later, (3) no additional acromegaly therapy prior to surgery or during the period of observation reported in this study, (4) no diabetes mellitus at initial or follow up testing. Our study included all consecutive patients meeting all of these criteria and excluded any who did not meet 1 or more of them. Those excluded included 12 patients who were followed for
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