Georgiana Dobri1,2, Soamsiri Niwattisaiwong3, James F Bena4, Manjula Gupta5, John Kirwan6, Lawrence Kennedy7, Amir H Hamrahian8. 1. Department of Neurosurgery Weill Cornell Medicine, New York, NY, 10065, USA. ged9047@med.cornell.edu. 2. Division of Endocrinology, Diabetes and Metabolism Weill Cornell Medicine, New York, NY, 10065, USA. ged9047@med.cornell.edu. 3. Department of Endocrinology Sanford Health Fargo, North Dakota, 58100, USA. 4. Department of Quantitative Health Sciences Cleveland Clinic, Cleveland, OH, 44195, USA. 5. Department of Laboratory Medicine, Cleveland Clinic, Cleveland, OH, 44195, USA. 6. Department of Integrated Physiology and Molecular Medicine, Pennington Biomedical Research Center, Baton Rouge, LA, 70808, USA. 7. Department of Endocrinology, Diabetes and Metabolism Cleveland Clinic, Cleveland, OH, 44195, USA. 8. Division of Endocrinology, Diabetes and Metabolism Johns Hopkins University, Baltimore, MD, 21287, USA.
Abstract
PURPOSE: The growth hormone (GH) nadir during oral glucose tolerance test (OGTT) is the gold standard diagnostic test for acromegaly. The utility of OGTT-GH suppression test in patients with abnormal glucose metabolism (AGM) has not been well established. In this study, we compared the GH nadir during OGTT in patients evaluated for acromegaly in the presence and absence of AGM. METHODS: This is a retrospective cohort study of patients with acromegaly (G1, n = 40) and a group in whom acromegaly was not confirmed (G2, n = 53) who had OGTT-GH suppression test during 2000-2012, using a monoclonal GH immunoenzymatic assay. The patients were categorized as having normal glucose metabolism (NGM) or AGM. GH nadir during OGTT in each group were compared. RESULTS: In G1 and G2, 17 and 19 patients had AGM, respectively. Among 17 patients with diabetes, median HbA1C was 7% (range 5.7-9.6%). All except one patient had HbA1C< 8%. There was no difference in the GH nadir in patients with or without AGM within G1 (p = 0.15) and G2 (p = 0.43). All G1 patients with AGM had GH nadir > 0.4 µg/L. Four G1 patients with NGM had GH nadir<0.4 µg/L. All G2 patients had GH nadir < 0.4 µg/L, except one with NGM and GH nadir of 0.4 µg/L. CONCLUSION: Using highly sensitive GH assay, a GH nadir ≥ 0.4 µg/L during the OGTT-GH suppression test may be used for diagnosis of acromegaly in patients with AGM in the absence of poorly controlled diabetes.
PURPOSE: The growth hormone (GH) nadir during oral glucose tolerance test (OGTT) is the gold standard diagnostic test for acromegaly. The utility of OGTT-GH suppression test in patients with abnormal glucose metabolism (AGM) has not been well established. In this study, we compared the GH nadir during OGTT in patients evaluated for acromegaly in the presence and absence of AGM. METHODS: This is a retrospective cohort study of patients with acromegaly (G1, n = 40) and a group in whom acromegaly was not confirmed (G2, n = 53) who had OGTT-GH suppression test during 2000-2012, using a monoclonal GH immunoenzymatic assay. The patients were categorized as having normal glucose metabolism (NGM) or AGM. GH nadir during OGTT in each group were compared. RESULTS: In G1 and G2, 17 and 19 patients had AGM, respectively. Among 17 patients with diabetes, median HbA1C was 7% (range 5.7-9.6%). All except one patient had HbA1C< 8%. There was no difference in the GH nadir in patients with or without AGM within G1 (p = 0.15) and G2 (p = 0.43). All G1 patients with AGM had GH nadir > 0.4 µg/L. Four G1 patients with NGM had GH nadir<0.4 µg/L. All G2 patients had GH nadir < 0.4 µg/L, except one with NGM and GH nadir of 0.4 µg/L. CONCLUSION: Using highly sensitive GH assay, a GH nadir ≥ 0.4 µg/L during the OGTT-GH suppression test may be used for diagnosis of acromegaly in patients with AGM in the absence of poorly controlled diabetes.
Authors: H Hanaire-Broutin; B Sallerin-Caute; M F Poncet; M Tauber; R Bastide; J J Chalé; R Rosenfeld; J P Tauber Journal: Diabetologia Date: 1996-12 Impact factor: 10.122
Authors: K L Clayton; J M Holly; L M Carlsson; J Jones; T D Cheetham; A M Taylor; D B Dunger Journal: Clin Endocrinol (Oxf) Date: 1994-10 Impact factor: 3.478