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Biochemical diagnosis and assessment of disease activity in acromegaly: a two-decade experience

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Abstract

The objective of this study is to assess the secretory pattern of GH after Oral Glucose Tolerance Test (OGTT) or day-curve (DC), in relation with IGF-I and to evaluate the influence of therapy on OGTT. A retrospective analysis in 279 OGTTs performed in 93 acromegalic patients in our unit from January 1988 to December 2005, in 77 patients also DC data were retrived. GH concentration was evaluated by 3 different systems (RIA, IRMA and chemiluminescence assays), and IGF-I by two RIAs. About 12% of OGTT samples were discordant with the baseline, while discordance between nadir and 120th minute was much lower (5%), with all discordant values, except one, near the cut-off lines. Correlation between DC and OGTT data was around 0.99 among all values, discordance rate between nadir and minimum DC was much lower than that with mean DC. In almost 80% of cases there was a complete concordance between OGTT and DC results, and in about 30% IGF-I was discordant with GH. Correlation analysis between IGF-I and GH was highest with DC data and lowest with OGTT baseline (T0). Considering different treatments discrepancy rates between GH and IGF-I were comparable. The best GH parameter is the minimum GH DC, although in the clinical practice the evaluation of OGTT GH in association with IGF-I is the most practical approach. In this case, the basal and T120 GH values can replace multiple sampling. Different treatment modalities do not influence the discordance rate between GH and IGF-I.

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References

  1. Melmed S (2006) Medical progress: acromegaly. N Engl J Med 355:2558–2573

    Article  PubMed  CAS  Google Scholar 

  2. Alexander L, Appleton D, Hall R, Ross WM, Wilkinson R (1980) Epidemiology of acromegaly in the Newcastle region. Clin Endocrinol (Oxf) 12:71–79

    Article  CAS  Google Scholar 

  3. Bengtsson BA, Eden S, Ernest I, Oden A, Sjogren B (1988) Epidemiology and long-term survival in acromegaly. A study of 166 cases diagnosed between 1955 and 1984. Acta Med Scand 223:327–335

    Article  PubMed  CAS  Google Scholar 

  4. Colao A, Ferone D, Marzullo P, Lombardi G (2004) Systemic complications of acromegaly: epidemiology, pathogenesis, and management. Endocr Rev 25:102–152

    Article  PubMed  CAS  Google Scholar 

  5. Holdaway IM, Rajasoorya C (1999) Epidemiology of acromegaly. Pituitary 2:29–41

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  7. Strasburger CJ (2005) IGF-I and mortality in patients with acromegaly. J Endocrinol Invest 28:78–80

    PubMed  CAS  Google Scholar 

  8. 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 Endocr Metab 85:526–529

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  10. Clemmons DR (2011) Consensus statement on the standardization and evaluation of growth hormone and insulin-like growth factor assays. Clin Chem 57:555–559

    Article  PubMed  CAS  Google Scholar 

  11. Minuto F, Resmini E, Boschetti M, Arvigo M, Sormani MP, Giusti M, Ferone D, Barreca A (2004) Assessment of disease activity in acromegaly by means of a single blood sample: comparison of the 120th minute postglucose value with spontaneous GH secretion and with the IGF system. Clin Endocrinol (Oxf) 61:138–144

    Article  CAS  Google Scholar 

  12. expert committee on the diagnosis, classification of diabetes mellitus (2003) Report of the Expert Committee on the diagnosis and classification of diabetes mellitus. Diabetes Care 26(Suppl 1):S5–S20

    Google Scholar 

  13. Carmichael JD, Bonert VS, Mirocha JM, Melmed S (2009) The utility of oral glucose tolerance testing for diagnosis and assessment of treatment outcomes in 166 patients with acromegaly. J Clin Endocrinol Metab 94:523–527

    Article  PubMed  CAS  Google Scholar 

  14. Bland JM, Altman DG (1986) Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1:307–310

    Article  PubMed  CAS  Google Scholar 

  15. Grottoli S, Razzore P, Gaia D, Gasperi M, Giusti M, Colao A, Ciccarelli E, Gasco V, Martino E, Ghigo E, Camanni F (2003) 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

    PubMed  CAS  Google Scholar 

  16. Ribeiro-Oliveira A Jr, Faje AT, Barkan AL (2011) Limited utility of oral glucose tolerance test in biochemically active acromegaly. Eur J Endocrinol 164:17–22

    Article  PubMed  CAS  Google Scholar 

  17. Melmed S, Casanueva F, Cavagnini F, Chanson P, Frohman LA, Gaillard R, Ghigo E, Ho K, Jaquet P, Kleinberg D, Lamberts S, Laws E, Lombardi G, Sheppard MC, Thorner M, Vance ML, Wass JA, Giustina A (2005) Consensus statement: medical management of acromegaly. Eur J Endocrinol 153:737–740

    Article  PubMed  CAS  Google Scholar 

  18. Melmed S, Colao A, Barkan A, Molitch M, Grossman AB, Kleinberg D, Clemmons D, Chanson P, Laws E, Schlechte J, Vance ML, Ho K, Giustina A (2009) Guidelines for acromegaly management: an update. J Clin Endocrinol Metab 94:1509–1517

    Article  PubMed  CAS  Google Scholar 

  19. Arafat AM, Mohlig M, Weickert MO, Perschel FH, Purschwitz J, Spranger J, Strasburger CJ, Schofl C, Pfeiffer AF (2008) Growth hormone response during oral glucose tolerance test: the impact of assay method on the estimation of reference values in patients with acromegaly and in healthy controls, and the role of gender, age, and body mass index. J Clin Endocrinol Metab 93:1254–1262

    Article  PubMed  CAS  Google Scholar 

  20. Murray RD, Kim K, Ren SG, Chelly M, Umehara Y, Melmed S (2004) Central and peripheral actions of somatostatin on the growth hormone-IGF-I axis. J Clin Invest 114:349–356

    PubMed  CAS  Google Scholar 

  21. Barkan AL, Beitins IZ, Kelch RP (1988) Plasma insulin-like growth factor-I/somatomedin-C in acromegaly: correlation with the degree of growth hormone hypersecretion. J Clin Endocrinol Metab 67:69–73

    Article  PubMed  CAS  Google Scholar 

  22. Barreca A, Ciccarelli E, Minuto F, Bruzzi P, Giordano G, Camanni F (1989) Insulin-like growth factor I and daily growth hormone profile in the assessment of active acromegaly. Acta Endocrinol Copenh 120:629–635

    PubMed  CAS  Google Scholar 

  23. Melmed S (2009) Acromegaly pathogenesis and treatment. J Clin Invest 119:3189–3202

    Article  PubMed  CAS  Google Scholar 

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Acknowledgments

This study was partially supported by grants from MIUR (2002067251-001, 2007RFFFFN_005), from University of Genova and by grant from Italian Minister of Instruction, University and Research (PRIN 2008 n. 2008LFK7J5_004).

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Authors and Affiliations

  1. Department of Endocrine and Medical Sciences, University of Genova, Viale Benedetto XV 6, 16132, Genoa, Italy

    Francesco M. Minuto, Eugenia Resmini, Mara Boschetti, Alberto Rebora, Laura Fazzuoli, Marica Arvigo, Massimo Giusti & Diego Ferone

  2. Center of Excellence for Biomedical Research, University of Genova, Genoa, Italy

    Francesco M. Minuto, Mara Boschetti, Marica Arvigo, Massimo Giusti & Diego Ferone

Authors
  1. Francesco M. Minuto
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  2. Eugenia Resmini
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  3. Mara Boschetti
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  4. Alberto Rebora
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  5. Laura Fazzuoli
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  6. Marica Arvigo
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  7. Massimo Giusti
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  8. Diego Ferone
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Correspondence to Francesco M. Minuto.

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Minuto, F.M., Resmini, E., Boschetti, M. et al. Biochemical diagnosis and assessment of disease activity in acromegaly: a two-decade experience. Pituitary 15, 215–221 (2012). https://doi.org/10.1007/s11102-011-0313-4

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  • DOI: https://doi.org/10.1007/s11102-011-0313-4

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