Serum IGF-1 In the Diagnosis of Acromegaly and the Profile of Patients with Elevated IGF-1 but Normal Glucose-Suppressed Growth Hormone |
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| Institution: | 1. Department of Endocrinology, Diabetes and Metabolism;2. Department of Anatomic Pathology;3. Department of Neurological Surgery, Cleveland Clinic, Cleveland, Ohio;4. Department of Medicine/ Endocrinology and Neurological Surgery, Northwest Pituitary Center, Oregon Health and Science University, Portland, Oregon;5. Division of Endocrinology, Allegheny Neuroendocrinology Center, Allegheny Hospital, Pittsburgh, Pennsylvania.;1. From the Ankara University Faculty of Medicine, Department of Endocrinology and Metabolism, Ankara, Turkey.;1. Department of Diagnostic Pathology, NTT Medical Center Tokyo, Tokyo, Japan;2. Department of General Thoracic Surgery, NTT Medical Center Tokyo, Tokyo, Japan;3. Department of Radiology, NTT Medical Center Tokyo, Tokyo, Japan;4. Department of Molecular Pathology, Tokyo Medical University, Tokyo, Japan;5. Department of Respiratory Medicine, NTT Medical Center Tokyo, Tokyo, Japan;6. Department of Pathology, Asahi General Hospital, Chiba, Japan;1. From the Department of Neurosurgery, Huashan Hospital, Shanghai Medical School, Fudan University, Shanghai, China;2. Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China;3. Medical Science in Clinical Investigation, Harvard Medical School, Boston, Massachusetts;4. Neurosurgical Institute of Fudan University, Shanghai, China;5. Shanghai Pituitary Tumor Center, Shanghai, China;6. State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai, China;7. National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China;8. Department of Endocrinology, Huashan Hospital, Shanghai Medical School, Fudan University, Shanghai, China;9. Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts. |
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| Abstract: | ObjectiveTo report the utility of insulin-like growth factor-1 (IGF-1) as a single biomarker for establishing the diagnosis of acromegaly and to examine the clinical and biochemical profile of patients with an elevated IGF-1 in whom a diagnosis of acromegaly could not be confirmed by means of the oral glucose tolerance test (OGTT).MethodsBetween the years 1999 and 2010, we identified 101 patients who underwent pituitary surgery and had histologically proven somatotroph adenomas (Group 1, Gr 1). We selected 149 patients with non- growth hormone (GH) secreting pituitary macroadenomas (Gr 2, n = 97) and microadenomas (Gr 3, n = 52) to serve as control subjects. In addition, we identified 34 patients with elevated IGF-1values in whom acromegaly could not subsequently be proven by the OGTT (Gr 4).ResultsIGF-1 was elevated in all patients with acromegaly prior to therapy with a median (range) standard deviation score (SDS) of + 9.52 (+ 2.34 to + 9.2), compared to SDS ? 1.46 (? 2.91 to + 2.17) and ? 1.22 (? 2.8 to + 1.58) in Gr 2 and 3, respectively (P < 0.001). IGF- 1 SDS values were + 3.28 (+ 2.05 to + 6.1), and IGF-1 was less than twice the upper limit of normal in all patients in Gr 4. OGTT was performed in 51 of the 101 acromegalic patients. The nadir GH in these patients was 4.01 (0.2 to 46.7) in comparison with 0.2 (< 0.05 to 0.6) in Gr 4 (P < 0.001).ConclusionElevated IGF-1 levels, alone, are sufficient to establish a diagnosis of acromegaly in the majority of clinically suspected cases. The OGTT may be useful to obtain corroborative evidence when there is modest elevation of IGF-1 with absent or equivocal clinical features. (Endocr Pract. 2012;18:817-825) |
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