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Discordance between growth hormone and insulin-like growth factor-1 after pituitary surgery for acromegaly: a stepwise approach and management

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Abstract

Introduction

Follow-up management of patients with acromegaly after pituitary surgery is performed by conducting biochemical assays of growth hormone (GH) and insulin-like growth factor-1 (IGF1). Despite concordant results of these two tests in the majority of cases, there is increasing recognition of patients who show persistent or intermittent discordance between GH and IGF1 (normal GH and elevated IGF1 or vice versa).

Method

In this narrative review, the last three decades materials on the issue of discrepancy between GH and IGF1 were thoroughly assessed.

Results

Various studies have obtained different discordance rates, ranging from 5.4 to 39.5 %. At present, despite the use of current sensitive assays and more stringent criteria to define remission, the rate of discordance still remains high. A number of mechanisms have been proposed to explain the postoperative discordance of GH and IGF1 including; altered dynamics of the GH secretion after surgery, early postoperative hormone assay, inaccurate or less sensitive tests and laboratory errors, too high cut-off point for GH suppression in the GH assays, GH nadir values not adjusted to age, sex, and body mass index, the influence of concomitant medication, co-existing physiologic and pathologic conditions, and many other proposed reasons. Nevertheless, the underlying mechanisms are still far from clear, and the solution continues to evade complete elucidation. Similarly, the impacts of such a discrepancy over mortality and morbidity and the risk of biochemical and/or clinical recurrence are unclear.

Conclusion

As a challenging clinical problem, a stepwise evaluation and management of these patients appears to be more rational.

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Acknowledgments

The authors wish to thank Dr. Zahid Hussain Khan for editing this manuscript.

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Neurological Surgery, Imam Khomeini Hospital, Tehran University of Medical Sciences, 1419733141, Tehran, Iran

    Mehdi Zeinalizadeh & Zohreh Habibi

  2. Brain and Spinal Cord Injuries Repair Research Center (BASIR), Pituitary Clinic, Imam Khomeini Hospital, 1419733141, Tehran, Iran

    Mehdi Zeinalizadeh & Zohreh Habibi

  3. Department of Neurological Surgery, UPMC Presbyterian, Suite B-400, University of Pittsburgh Medical Center, 200 Lothrop Street, Pittsburgh, PA, 15213, USA

    Juan C. Fernandez-Miranda & Paul A. Gardner

  4. Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA

    Steven P. Hodak & Sue M. Challinor

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  1. Mehdi Zeinalizadeh
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  2. Zohreh Habibi
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  3. Juan C. Fernandez-Miranda
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  4. Paul A. Gardner
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Correspondence to Mehdi Zeinalizadeh.

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Zeinalizadeh, M., Habibi, Z., Fernandez-Miranda, J.C. et al. Discordance between growth hormone and insulin-like growth factor-1 after pituitary surgery for acromegaly: a stepwise approach and management. Pituitary 18, 48–59 (2015). https://doi.org/10.1007/s11102-014-0556-y

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