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Three-hour spontaneous GH secretion profile is as reliable as oral glucose tolerance test for the diagnosis of acromegaly

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Abstract

The diagnosis of acromegaly, in an appropriate clinical context, usually relies on lack of GH suppression below 1 μg/l during OGTT coupled with elevated IGF-I levels. On the other hand, in normal subjects glucose-induced inhibition of GH secretory bursts without any further decrease of interpulse GH levels had already been shown. Based on the foregoing, we aimed to compare the diagnostic reliability of OGTT-induced GH nadir with that recorded during 3-h spontaneous GH secretion. In 59 acromegalic patients (17 male and 42 female, age, mean±SE 51.5±1.9, range 21–76 yr) and in 82 normal subjects (43 male and 39 female, age, mean±SE 35.7±1.5, range 15–72 yr) GH secretion was evaluated every 30 min from 0 to 180 min during slow saline infusion or OGTT (75 g at 0 min). A nadir GH concentration below 1 μg/l was recorded in all normal subjects either during OGTT or saline infusion if GH secretion was evaluated over 180 min. In contrast in acromegalic patients a nadir GH concentration below 1 μg/l never occurred in both conditions. This study shows that a 3-h spontaneous GH profile is as reliable as OGTT in the diagnosis of active acromegaly.

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References

  1. Daughaday W.H., Starkey R.H., Saltman S., Gavin G.R. III, Mills-Dunlap B., Health-Monning E. Characterization of serum growth-hormone (GH) and insulin-like growth factor I in active acromegaly with minimal elevation of serum GH. J. Clin. Endocrinol. Metab. 1987, 65: 617–623.

    Article  PubMed  CAS  Google Scholar 

  2. Hoffenberg R., Howell A., Epstein S. et al. Increasing growth with raise circulating somatomedin but normal immunoassayable growth hormone. Clin. Endocrinol. 1977, 6: 443–448.

    Article  CAS  Google Scholar 

  3. Mims R.B., Bethune J.E. Acromegaly with normal fasting growth hormone concentrations but abnormal growth hormone regulation. Ann. Intern. Med. 1974, 81: 781–784.

    Article  PubMed  CAS  Google Scholar 

  4. Melmed S., Ho K., Klibanski A., Reichlin S., Thorner M. Recents advances in pathogenesis, diagnosis and management of acromegaly. J. Clin. Endocrinol. Metab. 1995, 80: 3395–3402.

    PubMed  CAS  Google Scholar 

  5. Giustina A., Barkan A., Casanueva F.F. et al. Criteria for cure of acromegaly: a consensus statement. J. Clin. Endocrinol. Metab. 2000, 85: 526–529.

    PubMed  CAS  Google Scholar 

  6. Clemmons D.R., Van Wyck J.J., Ridgway E.D.C., Kliman B., Kjellberg R.N., Underwood L.E. Evaluation of acromegaly by radioimmunoassay of somatomedin-C. N. Engl. J. Med. 1979, 301: 1138–1142.

    Article  PubMed  CAS  Google Scholar 

  7. Barkan A.L., Beitins I.Z., Kelch R.P. Plasma insulin-like growth factor-I/somatomedin-C in acromegaly: correlation with the degree of growth hormone hypersecretion. J. Clin. Endocrinol. Metab. 1988, 67: 69–73.

    Article  PubMed  CAS  Google Scholar 

  8. Ho K.K.Y., Weissberger A.J. Characterization of 24-hour growth hormone secretion in acromegaly: implications for diagnosis and therapy. Clin. Endocrinol. 1994, 41: 75–83.

    Article  CAS  Google Scholar 

  9. Rieu M., Girard F., Bricare H., Binoux M. The importance of insulin-like growth factor (somatomedin) measurements in the diagnosis and surveillance of acromegaly. J. Clin. Endocrinol Metab. 1982, 55: 147–153.

    Article  PubMed  CAS  Google Scholar 

  10. Stoffel-Wagner B., Springer W., Bidlingmaier F., Klingmuller D. A comparison of different methods for diagnosing acromegaly. Clin. Endocrinol. 1997, 46: 531–537.

    Article  CAS  Google Scholar 

  11. Jasper H., Pennisi P., Vitale M., Mella A., Ropelato G., Chervin A. Evaluation of disease activity by IGF-I and IGF binding protein-3 (IGFBP3) in acromegaly patients distribuited according to a clinical score. J. Endocrinol. Invest. 1999, 22: 29–34.

    Article  PubMed  CAS  Google Scholar 

  12. Smith W.J., Underwood L.E., Clemmons D.R. Effects of caloric or protein restriction on insulin-like growth factor-I (IGF-I) and IGF-binding proteins in children and adults. J. Clin. Endocrinol. Metab. 1995, 80: 443–449.

    PubMed  CAS  Google Scholar 

  13. Thissen J.P., Ketelslegers J.M., Underwood L.E. Nutritional regulation of the insulin-like growth factors. Endocrine. Rev. 1994, 15: 80–101.

    CAS  Google Scholar 

  14. Hall K., Hilding A., Thoren M. Determinants of circulating insulin-like growth factor-I. J. Endocrinol. Invest. 1999, 22: 48–57

    PubMed  CAS  Google Scholar 

  15. Corpas E., Harman S.M., Blackman M.R. Human growth hormone and human aging. Endocrine Rev. 1993, 14: 20–39.

    Article  CAS  Google Scholar 

  16. Ghigo E., Aimaretti G., Gianotti L., Bellone J., Arvat E., Camanni F. New approach to the diagnosis of growth hormone deficiency in adults. Eur. J. Endocrinol. 1996, 134: 352–356.

    Article  PubMed  CAS  Google Scholar 

  17. Duncan E., Wass J.A.H. Investigation protocol: acromegaly and its investigation. Clin. Endocrinol. 1999, 50: 285–293.

    Article  CAS  Google Scholar 

  18. Earll J.M., Sparks L.L., Forsham PH. Glucose suppression of serum growth hormone in the diagnosis of acromegaly. J. Am. Med. Ass. 1967, 201: 134–136.

    Article  Google Scholar 

  19. Chapman I.M., Hartman M.L., Straume M., Johnson M.L., Veldhuis J.D., Thorner M.O. Enhanced sensitivity growth hormone (GH) chemiluminescence assay reveals lower postglucose nadir GH concentrations in men than in women. J. Clin. Endocrinol. Metab. 1994, 78: 1312–1319.

    PubMed  CAS  Google Scholar 

  20. Colao A., Lombardi G. Growth-hormone and prolactin excess. Lancet 1998; 352: 1455–1461.

    Article  PubMed  CAS  Google Scholar 

  21. Grecu E.O., Walter R.M., Gold E.M. Paradoxical release of growth hormone during oral glucose tolerance test in patients with abnormal glucose tolerance. Metabolism 1983, 32: 134–137.

    Article  PubMed  CAS  Google Scholar 

  22. Becker M.D., Cook G.C., Wright A.D. Paradoxical elevation of growth hormone in active chronic hepatitis. Lancet 1969, 2: 1035–1039.

    Article  PubMed  CAS  Google Scholar 

  23. Tamai H., Kiyohara K., Mukuta Y. et al. Responses of growth hormone and cortisol to intravenous glucose loading test in patients with anorexia nervosa. Metabolism 1991, 40: 31–34.

    Article  PubMed  CAS  Google Scholar 

  24. Maccario M., Procopio M., Grottoli S. et al. In obesity the somatotrope response to either GHRH or arginine is inhibited by somatostatin or pirenzepine but not by glucose. J. Clin. Endocrinol. Metab. 1995, 80: 3774–3778.

    PubMed  CAS  Google Scholar 

  25. Grottoli S., Maccario M., Procopio M. et al. The somatotrope responsiveness to hexarelin, synthetic hexapeptidde, is refractory to the inhibitory effect of glucose in obesity. Eur. J. Endocrinol. 1995, 135: 678–682.

    Article  Google Scholar 

  26. Semer M., Faria A.C.S., Nery M. et al. Growth hormone pulsatility in active and cured acromegalic subjects. J. Clin. Endocrinol. Metab. 1995, 80: 3767–3770.

    PubMed  CAS  Google Scholar 

  27. Iranmanesh A., Grisso B., Veldhuis J.D. Low basal and persistent pulsatile growth hormone secretion are revealed in normal and hyposomatropic men studied with a new ultrasensitive chemiluminescence assay. J. Clin. Endocrinol. Metab. 1994, 78: 526–535.

    PubMed  CAS  Google Scholar 

  28. Melmed S., Jackson I., Klienberg D., Klibanski A. Current treatment guidelines for acromegaly. J. Clin. Endocrinol. Metab. 1998, 83: 2646–2652.

    PubMed  CAS  Google Scholar 

  29. Hattori N., Shimatsu A., Kato Y. et al. Growth hormone responses to oral glucose loading measured by highly sensitive enzyme immunoassay in normal subjects and patients with glucose intolerance and acromegaly. J. Clin. Endocrinol. Metab. 1990, 70: 771–776.

    Article  PubMed  CAS  Google Scholar 

  30. Wass J.A.H. Growth hormone, insulin-like growth factor-I and its binding proteins in follow-up of acromegaly. J. Endocrinol. 1997, 155: S17–S19.

    PubMed  CAS  Google Scholar 

  31. Freda P.U., Kalmon D.P., Jefrey S.P., Sharon L.W. Evaluation of the disease status with sensitive measures of growth hormone secretion in 60 postoperative patients with acromegaly. J. Clin. Endocrinol. Metab. 1998, 83: 3808–3816.

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Division of Endocrinology and Metabolism, Department of Internal Medicine, University of Turin, C.so Dogliotti 14, 10126, Turin, Italy

    S. Grottoli, P. Razzore, D. Gaia, E. Ciccarelli, V. Gasco, E. Ghigo &  F. Camanni

  2. Department of Endocrinology, University of Pisa, Pisa, Italy

    M. Gasperi & E. Martino

  3. DISEM, University of Genova, Genova, Italy

    M. Giusti

  4. Department of Molecular and Clinical Endocrinology and Oncology, ’Federico II’ University, Naples, Naples, Italy

    A. Colao

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  1. S. Grottoli
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  2. P. Razzore
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  3. D. Gaia
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  4. M. Gasperi
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  5. M. Giusti
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  6. A. Colao
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  7. E. Ciccarelli
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  8. V. Gasco
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  9. E. Martino
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  10. E. Ghigo
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  11. F. Camanni
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Correspondence to F. Camanni.

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Grottoli, S., Razzore, P., Gaia, D. et al. Three-hour spontaneous GH secretion profile is as reliable as oral glucose tolerance test for the diagnosis of acromegaly. J Endocrinol Invest 26, 123–127 (2003). https://doi.org/10.1007/BF03345139

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  • DOI: https://doi.org/10.1007/BF03345139

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