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Growth hormone measurements in the diagnosis and monitoring of acromegaly

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Abstract

Before the availability of immunoassays for IGF-I, growth hormone (GH) measurement was the sole method used in the biochemical assessment of acromegaly. IGF-I has since been established as the most reliable biochemical indicator of acromegaly. The last 25 years has seen important advances in the understanding of the neuroregulation and in the characterization of GH secretion in acromegaly. The availability of supersensitive GH has changed many aspects of the interpretation of GH-value in the management of acromegaly. Hypersecretion and abnormal neuroregulation characterize GH secretion in acromegaly. GH can be measured in many ways: as a single random sample, as multiple samples, either spontaneously or as an integral part of a dynamic test. These approaches give useful information on diagnosis, therapy, and prognosis. There is a place for measuring GH in the management of acromegaly although it complements that of IGF-I.

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References

  1. Ho KY, Weissberger AJ (1994) Characterization of 24-hour growth hormone secretion in acromegaly: implications for diagnosis and therapy. Clin Endocrinol (Oxf) 41:75–83

    CAS  Google Scholar 

  2. Kojima M, Hosoda H, Date Y, Nakazato M, Matsuo H, Kangawa K (1999) Ghrelin is a growth-hormone-releasing acylated peptide from stomach. Nature 402:656–660

    Article  PubMed  CAS  Google Scholar 

  3. Takaya K, Ariyasu H, Kanamoto N, Iwakura H, Yoshimoto A, Harada M, Mori K, Komatsu Y, Usui T, Shimatsu A, Ogawa Y, Hosoda K, Akamizu T, Kojima M, Kangawa K, Nakao K (2000) Ghrelin strongly stimulates growth hormone release in humans. J Clin Endocrinol Metab 85:4908–4911

    Article  PubMed  CAS  Google Scholar 

  4. Hataya Y, Akamizu T, Takaya K, Kanamoto N, Ariyasu H, Saijo M, Moriyama K, Shimatsu A, Kojima M, Kangawa K, Nakao K (2001) A low dose of ghrelin stimulates growth hormone (GH) release synergistically with GH-releasing hormone in humans. J Clin Endocrinol Metab 86:4552

    Article  PubMed  CAS  Google Scholar 

  5. Tannenbaum GS, Epelbaum J, Bowers CY (2003) Interrelationship between the novel peptide ghrelin and somatostatin/growth hormone-releasing hormone in regulation of pulsatile growth hormone secretion. Endocrinology 144:967–974

    Article  PubMed  CAS  Google Scholar 

  6. Giustina A, Veldhuis JD (1998) Pathophysiology of the neuroregulation of growth hormone secretion in experimental animals and the human. Endocr Rev 19:717–797

    Article  PubMed  CAS  Google Scholar 

  7. Duncan E, Wass JA (1999) Investigation protocol: acromegaly and its investigation. Clin Endocrinol (Oxf) 50:285–293

    Article  CAS  Google Scholar 

  8. Bertherat J, Bluet-Pajot MT, Epelbaum J (1995) Neuroendocrine regulation of growth hormone. Eur J Endocrinol 132:12–24

    Article  PubMed  CAS  Google Scholar 

  9. Melmed SaK D (2003) (ed) Williams textbook of endocrinology 10th edn. Saunders, Philadelphia

    Google Scholar 

  10. Fiasche R, Fideleff HL, Moisezowicz J, Frieder P, Pagano SM, Holland M (1995) Growth hormone neurosecretory disfunction in major depressive illness. Psychoneuroendocrinology 20:727–733

    Article  PubMed  CAS  Google Scholar 

  11. Sakkas PN, Soldatos CR, Bergiannaki JD, Paparrigopoulos TJ, Stefanis CN (1998) Growth hormone secretion during sleep in male depressed patients. Prog Neuropsychopharmacol Biol Psychiatry 22:467–483

    Article  PubMed  CAS  Google Scholar 

  12. Ho KY, Veldhuis JD, Johnson ML, Furlanetto R, Evans WS, Alberti KG, Thorner MO (1988) Fasting enhances growth hormone secretion and amplifies the complex rhythms of growth hormone secretion in man. J Clin Invest 81:968–975

    PubMed  CAS  Google Scholar 

  13. Hartman ML, Pincus SM, Johnson ML, Matthews DH, Faunt LM, Vance ML, Thorner MO, Veldhuis JD (1994) Enhanced basal and disorderly growth hormone secretion distinguish acromegalic from normal pulsatile growth hormone release. J Clin Invest 94:1277–1288

    PubMed  CAS  Google Scholar 

  14. Hartman ML, Veldhuis JD, Vance ML, Faria AC, Furlanetto RW, Thorner MO (1990) Somatotropin pulse frequency and basal concentrations are increased in acromegaly and are reduced by successful therapy. J Clin Endocrinol Metab 70:1375–1384

    PubMed  CAS  Google Scholar 

  15. Barkan AL, Stred SE, Reno K, Markovs M, Hopwood NJ, Kelch RP, Beitins IZ (1989) Increased growth hormone pulse frequency in acromegaly. J Clin Endocrinol Metab 69:1225–1233

    Article  PubMed  CAS  Google Scholar 

  16. Riedel M, Gunther T, von zur Muhlen A, Brabant G (1992) The pulsatile GH secretion in acromegaly: hypothalamic or pituitary origin? Clin Endocrinol (Oxf) 37:233–239

    CAS  Google Scholar 

  17. Gelato MC, Oldfield E, Loriaux DL, Merriam GR (1990) Pulsatile growth hormone secretion in patients with acromegaly and normal men: the effects of growth hormone-releasing hormone infusion. J Clin Endocrinol Metab 71:585–590

    PubMed  CAS  Google Scholar 

  18. Roelfsema F, de Boer H, Frolich M (1990) The influence of octreotide treatment on pulsatile growth hormone release in acromegaly. Clin Endocrinol (Oxf) 33:297–306

    CAS  Google Scholar 

  19. Ho PJ, Friberg RD, Barkan AL (1992) Regulation of pulsatile growth hormone secretion by fasting in normal subjects and patients with acromegaly. J Clin Endocrinol Metab 75:812–819

    Article  PubMed  CAS  Google Scholar 

  20. Yamada M, Monden T, Satoh T, Satoh N, Murakami M, Iriuchijima T, Kakegawa T, Mori M (1993) Pituitary adenomas of patients with acromegaly express thyrotropin-releasing hormone receptor messenger RNA: cloning and functional expression of the human thyrotropin-releasing hormone receptor gene. Biochem Biophys Res Commun 195:737–745

    Article  PubMed  CAS  Google Scholar 

  21. Le Dafniet M, Lefebvre P, Barret A, Mechain C, Feinstein MC, Brandi AM, Peillon F (1990) Normal and adenomatous human pituitaries secrete thyrotropin-releasing hormone in vitro: modulation by dopamine, haloperidol, and somatostatin. J Clin Endocrinol Metab 71:480–486

    Article  PubMed  CAS  Google Scholar 

  22. Pagesy P, Croissandeau G, Le Dafniet M, Peillon F, Li JY (1992) Detection of thyrotropin-releasing hormone (TRH) mRNA by the reverse transcription-polymerase chain reaction in the human normal and tumoral anterior pituitary. Biochem Biophys Res Commun 182:182–187

    Article  PubMed  CAS  Google Scholar 

  23. Ray D, Melmed S (1997) Pituitary cytokine and growth factor expression and action. Endocr Rev 18:206–228

    Article  PubMed  CAS  Google Scholar 

  24. Ehrchen J, Peters A, Ludecke DK, Visser T, Bauer K (2000) Analysis of thyrotropin-releasing hormone-signaling components in pituitary adenomas of patients with acromegaly. J Clin Endocrinol Metab 85:2709–2713

    Article  PubMed  CAS  Google Scholar 

  25. Giustina A, Barkan A, Casanueva FF, Cavagnini F, Frohman L, Ho K, Veldhuis J, Wass J, Von Werder K, Melmed S (2000) Criteria for cure of acromegaly: a consensus statement. J Clin Endocrinol Metab 85:526–529

    Article  PubMed  CAS  Google Scholar 

  26. Freda PU (2003) Current concepts in the biochemical assessment of the patient with acromegaly. Growth Horm IGF Res 13:171–184

    Article  PubMed  CAS  Google Scholar 

  27. Freda PU, Reyes CM, Nuruzzaman AT, Sundeen RE, Bruce JN (2003) Basal and glucose-suppressed GH levels less than 1 microg/L in newly diagnosed acromegaly. Pituitary 6:175–180

    Article  PubMed  CAS  Google Scholar 

  28. Dimaraki EV, Jaffe CA, DeMott-Friberg R, Chandler WF, Barkan AL (2002) Acromegaly with apparently normal GH secretion: implications for diagnosis and follow-up. J Clin Endocrinol Metab 87:3537–3542

    Article  PubMed  CAS  Google Scholar 

  29. Kaltsas GA, Isidori AM, Florakis D, Trainer PJ, Camacho-Hubner C, Afshar F, Sabin I, Jenkins JP, Chew SL, Monson JP, Besser GM, Grossman AB (2001) Predictors of the outcome of surgical treatment in acromegaly and the value of the mean growth hormone day curve in assessing postoperative disease activity. J Clin Endocrinol Metab 86:1645–1652

    Article  PubMed  CAS  Google Scholar 

  30. Stonesifer LD, Jordan RM, Kohler PO (1981) Somatomedin C in treated acromegaly: poor correlation with growth hormone and clinical response. J Clin Endocrinol Metab 53:931–934

    PubMed  CAS  Google Scholar 

  31. Jadresic A, Banks LM, Child DF, Diamant L, Doyle FH, Fraser TR, Joplin GF (1982) The acromegaly syndrome. Relation between clinical features, growth hormone values and radiological characteristics of the pituitary tumours. Q J Med 51:189–204

    PubMed  CAS  Google Scholar 

  32. Quabbe HJ (1982) Treatment of acromegaly by trans-sphenoidal operation, 90-yttrium implantation and bromocriptine: results in 230 patients. Clin Endocrinol (Oxf) 16:107–119

    CAS  Google Scholar 

  33. Nabarro JD (1987) Acromegaly. Clin Endocrinol (Oxf) 26:481–512

    CAS  Google Scholar 

  34. Stewart PM, Smith S, Seth J, Stewart SE, Cole D, Edwards CR (1989) Normal growth hormone response to the 75 g oral glucose tolerance test measured by immunoradiometric assay. Ann Clin Biochem 26(Pt 2):205–206

    PubMed  CAS  Google Scholar 

  35. Chapman IM, Hartman ML, Straume M, Johnson ML, Veldhuis JD, Thorner MO (1994) Enhanced sensitivity growth hormone (GH) chemiluminescence assay reveals lower postglucose nadir GH concentrations in men than women. J Clin Endocrinol Metab 78:1312–1319

    Article  PubMed  CAS  Google Scholar 

  36. Trainer PJ (2002) Editorial: acromegaly—consensus, what consensus? J Clin Endocrinol Metab 87:3534–3536

    Article  PubMed  CAS  Google Scholar 

  37. Freda PU, Landman RE, Sundeen RE, Post KD (2001) Gender and age in the biochemical assessment of cure of acromegaly. Pituitary 4:163–171

    Article  PubMed  CAS  Google Scholar 

  38. Costa AC, Rossi A, Martinelli CE Jr, Machado HR, Moreira AC (2002) Assessment of disease activity in treated acromegalic patients using a sensitive GH assay: should we achieve strict normal GH levels for a biochemical cure? J Clin Endocrinol Metab 87:3142–3147

    Article  PubMed  CAS  Google Scholar 

  39. Ho KY, Evans WS, Blizzard RM, Veldhuis JD, Merriam GR, Samojlik E, Furlanetto R, Rogol AD, Kaiser DL, Thorner MO (1987) Effects of sex and age on the 24-hour profile of growth hormone secretion in man: importance of endogenous estradiol concentrations. J Clin Endocrinol Metab 64:51–58

    PubMed  CAS  Google Scholar 

  40. Weltman A, Weltman JY, Hartman ML, Abbott RD, Rogol AD, Evans WS, Veldhuis JD (1994) Relationship between age, percentage body fat, fitness, and 24-hour growth hormone release in healthy young adults: effects of gender. J Clin Endocrinol Metab 78:543–548

    Article  PubMed  CAS  Google Scholar 

  41. Irie M, Tsushima T (1972) Increase of serum growth hormone concentration following thyrotropin-releasing hormone injection in patients with acromegaly or gigantism. J Clin Endocrinol Metab 35:97–100

    PubMed  CAS  Google Scholar 

  42. De Marinis L, Mancini A, Bianchi A, Gentilella R, Valle D, Giampietro A, Zuppi P, Anile C, Maira G, Giustina A (2002) Preoperative growth hormone response to thyrotropin-releasing hormone and oral glucose tolerance test in acromegaly: a retrospective evaluation of 50 patients. Metabolism 51:616–621

    Article  PubMed  CAS  Google Scholar 

  43. Thorner MO, Perryman RL, Cronin MJ, Rogol AD, Draznin M, Johanson A, Vale W, Horvath E, Kovacs K (1982) Somatotroph hyperplasia. Successful treatment of acromegaly by removal of a pancreatic islet tumor secreting a growth hormone-releasing factor. J Clin Invest 70:965–977

    Article  PubMed  CAS  Google Scholar 

  44. Gelato MC, Ross JL, Malozowski S, Pescovitz OH, Skerda M, Cassorla F, Loriaux DL, Merriam GR (1985) Effects of pulsatile administration of growth hormone (GH)-releasing hormone on short-term linear growth in children with GH deficiency. J Clin Endocrinol Metab 61:444–450

    Article  PubMed  CAS  Google Scholar 

  45. Shibasaki T, Hotta M, Masuda A, Imaki T, Obara N, Hizuka N, Takano K, Wakabayashi I, Demura H, Ling N et al (1986) Studies on the response of growth hormone (GH) secretion to GH-releasing hormone, thyrotropin-releasing hormone, gonadotropin-releasing hormone, and somatostatin in acromegaly. J Clin Endocrinol Metab 63:167–173

    Article  PubMed  CAS  Google Scholar 

  46. Freda PU, Post KD, Powell JS, Wardlaw SL (1998) Evaluation of disease status with sensitive measures of growth hormone secretion in 60 postoperative patients with acromegaly. J Clin Endocrinol Metab 83:3808–3816

    Article  PubMed  CAS  Google Scholar 

  47. Freda PU, Nuruzzaman AT, Reyes CM, Sundeen RE, Post KD (2004) Significance of “abnormal” nadir growth hormone levels after oral glucose in postoperative patients with acromegaly in remission with normal insulin-like growth factor-I levels. J Clin Endocrinol Metab 89:495–500

    Article  PubMed  CAS  Google Scholar 

  48. Melmed S (2001) Acromegaly and cancer: not a problem? J Clin Endocrinol Metab 86:2929–2934

    Article  PubMed  CAS  Google Scholar 

  49. Jenkins PJ (2006) Cancers associated with acromegaly. Neuroendocrinology 83:218–223

    Article  PubMed  CAS  Google Scholar 

  50. Abosch A, Tyrrell JB, Lamborn KR, Hannegan LT, Applebury CB, Wilson CB (1998) Transsphenoidal microsurgery for growth hormone-secreting pituitary adenomas: initial outcome and long-term results. J Clin Endocrinol Metab 83:3411–3418

    Article  PubMed  CAS  Google Scholar 

  51. Swearingen B, Barker FG II, Katznelson L, Biller BM, Grinspoon S, Klibanski A, Moayeri N, Black PM, Zervas NT (1998) Long-term mortality after transsphenoidal surgery and adjunctive therapy for acromegaly. J Clin Endocrinol Metab 83:3419–3426

    Article  PubMed  CAS  Google Scholar 

  52. Rajasoorya C, Holdaway IM, Wrightson P, Scott DJ, Ibbertson HK (1994) Determinants of clinical outcome and survival in acromegaly. Clin Endocrinol (Oxf) 41:95–102

    CAS  Google Scholar 

  53. Bates AS, Van’t Hoff W, Jones JM, Clayton RN (1993) An audit of outcome of treatment in acromegaly. Q J Med 86:293–299

    PubMed  CAS  Google Scholar 

  54. Orme SM, McNally RJ, Cartwright RA, Belchetz PE (1998) Mortality and cancer incidence in acromegaly: a retrospective cohort study. United Kingdom Acromegaly Study Group. J Clin Endocrinol Metab 83:2730–2734

    CAS  Google Scholar 

  55. Holdaway IM, Rajasoorya CR, Gamble GD, Stewart AW (2003) Long-term treatment outcome in acromegaly. Growth Horm IGF Res 13:185–192

    Article  PubMed  CAS  Google Scholar 

  56. Holdaway IM, Rajasoorya RC, Gamble GD (2004) Factors influencing mortality in acromegaly. J Clin Endocrinol Metab 89:667–674

    Article  PubMed  CAS  Google Scholar 

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Acknowledgments

Dr. Sata is a visiting fellow from the Tokyo Women’s Medical University, Tokyo and supported by the Foundation for the Growth Science, Japan.

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  1. Department of Endocrinology, St Vincent’s Hospital and the Garvan Institute of Medical Research, 384 Victoria Street, Darlinghurst, Sydney, NSW, 2010, Australia

    Akira Sata & Ken K. Y. Ho

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  1. Akira Sata
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  2. Ken K. Y. Ho
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Correspondence to Ken K. Y. Ho.

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Sata, A., Ho, K.K.Y. Growth hormone measurements in the diagnosis and monitoring of acromegaly. Pituitary 10, 165–172 (2007). https://doi.org/10.1007/s11102-007-0034-x

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