Pamela U Freda1, Jeffrey N Bruce2, Carlos Reyes-Vidal3, Simran Singh3, Yessica DeLeon4, Zhezhen Jin5, Alexander G Khandji6, Serge Cremers4, Kalmon D Post7. 1. Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, 650 West 168th Street, Rm.1014, New York, NY, 10032, USA. puf1@cumc.columbia.edu. 2. Department of Neurosurgery, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA. 3. Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, 650 West 168th Street, Rm.1014, New York, NY, 10032, USA. 4. Department of Pathology and Cell Biology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA. 5. Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA. 6. Department of Radiology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA. 7. Department of Neurosurgery, Mount Sinai School of Medicine, New York, NY, USA.
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 < 0.001). A total of 14 patients recurred, including 5 with normal GH suppression progressing to abnormal and then recurrence. Overall, serial signs and symptoms and insulin resistance assessments did not identify patients with abnormal suppression or recurrence. CONCLUSION: Risk of recurrence after surgery is increased for patients with a normal IGF-1 level, but abnormal GH suppression. We newly find, using both our and others' cut-offs, that while normal suppression predicts long-term remission in most patients, some can progress from normal to abnormal suppression and then recurrence after many years of follow up. Nadir GH levels are of prognostic value in acromegaly patients with normal IGF-1 levels after surgery.
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 < 0.001). A total of 14 patients recurred, including 5 with normal GH suppression progressing to abnormal and then recurrence. Overall, serial signs and symptoms and insulin resistance assessments did not identify patients with abnormal suppression or recurrence. CONCLUSION: Risk of recurrence after surgery is increased for patients with a normal IGF-1 level, but abnormal GH suppression. We newly find, using both our and others' cut-offs, that while normal suppression predicts long-term remission in most patients, some can progress from normal to abnormal suppression and then recurrence after many years of follow up. Nadir GH levels are of prognostic value in acromegaly patients with normal IGF-1 levels after surgery.
Authors: A M Arafat; L Müller; M Möhlig; B Mayr; N Kremenevskaya; A F H Pfeiffer; M Buchfelder; C Schöfl Journal: Clin Endocrinol (Oxf) Date: 2011-11 Impact factor: 3.478
Authors: Pamela U Freda; Abu T Nuruzzaman; Carlos M Reyes; Robert E Sundeen; Kalmon D Post Journal: J Clin Endocrinol Metab Date: 2004-02 Impact factor: 5.958
Authors: B Swearingen; F G Barker; L Katznelson; B M Biller; S Grinspoon; A Klibanski; N Moayeri; P M Black; N T Zervas Journal: J Clin Endocrinol Metab Date: 1998-10 Impact factor: 5.958