PURPOSE: Diagnosis of acromegaly in presence of uncontrolled diabetes mellitus is not well validated. METHOD: The study included 10 patients of active acromegaly with uncontrolled blood glucose, 10 patients of type 2 diabetes mellitus with poor glycemic control and 10 healthy subjects. The growth hormone level following oral glucose tolerance test and insulin-like growth factor-1 (IGF-1) and insulin-like growth factor-binding protein-3 (IGFBP-3) were done at baseline in all the 3 groups and it was repeated after short term glycemic control in type 2 diabetics and acromegalics with diabetics RESULTS: In the acromegalic group the basal GH value was very high (36.5 + 1.6) ng/ml and it was non-suppressible (32.5 + 1.43) ng/ml after OGTT. The mean IGF-1 and IGFBP-3 values were also high at baseline (208.38 + 38.51) ng/ml, and 7322 + 370 ng/ml respectively. In the non-acromegalic diabetic patients, the basal growth hormone value was marginally elevated (2.3 + 0.02) ng/ml. However, it was suppressible to 0.2 + 0.04 ng/ml after oral glucose load. In them the IGF-1 and IGFBP-3 values were not elevated and comparable to that of healthy controls. CONCLUSIONS: Basal serum GH and IGFBP-3 levels are not influenced by degree of glycemic control however serum IGF-1 levels should be interpreted with caution in patients of acromegaly with diabetes. Oral glucose load test has discriminating ability to diagnose acromegaly even with poorly controlled diabetes.
PURPOSE: Diagnosis of acromegaly in presence of uncontrolled diabetes mellitus is not well validated. METHOD: The study included 10 patients of active acromegaly with uncontrolled blood glucose, 10 patients of type 2 diabetes mellitus with poor glycemic control and 10 healthy subjects. The growth hormone level following oral glucose tolerance test and insulin-like growth factor-1 (IGF-1) and insulin-like growth factor-binding protein-3 (IGFBP-3) were done at baseline in all the 3 groups and it was repeated after short term glycemic control in type 2 diabetics and acromegalics with diabetics RESULTS: In the acromegalic group the basal GH value was very high (36.5 + 1.6) ng/ml and it was non-suppressible (32.5 + 1.43) ng/ml after OGTT. The mean IGF-1 and IGFBP-3 values were also high at baseline (208.38 + 38.51) ng/ml, and 7322 + 370 ng/ml respectively. In the non-acromegalic diabeticpatients, the basal growth hormone value was marginally elevated (2.3 + 0.02) ng/ml. However, it was suppressible to 0.2 + 0.04 ng/ml after oral glucose load. In them the IGF-1 and IGFBP-3 values were not elevated and comparable to that of healthy controls. CONCLUSIONS: Basal serum GH and IGFBP-3 levels are not influenced by degree of glycemic control however serum IGF-1 levels should be interpreted with caution in patients of acromegaly with diabetes. Oral glucose load test has discriminating ability to diagnose acromegaly even with poorly controlled diabetes.
Authors: Georgiana Dobri; Soamsiri Niwattisaiwong; James F Bena; Manjula Gupta; John Kirwan; Lawrence Kennedy; Amir H Hamrahian Journal: Endocrine Date: 2018-11-10 Impact factor: 3.633