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Optimal timing of blood samplings to detect GH inhibition during oral glucose tolerance test

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Abstract

Background

In patients with suspected acromegaly, evaluation of IGF-I is recommended as first-line test, while the assessment of GH-nadir during oral glucose tolerance test (OGTT) is advised as confirmatory test. The procedure of this test generally involves GH measurement every 30 min (30’) from baseline to +120’ or +180’. However, the optimal timing of samplings for the distinction between patients with or without active acromegaly is still a matter of debate.

Methods

Sixty-seven healthy subjects and 46 acromegalic patients who achieved documented and persistent long-term cure were enrolled. A greedy algorithm was used to identify the minimal subset of time-points that sufficed to correctly detect GH suppression.

Results

The sampling at 90’ was the one in which a GH level < 1 μg/L was most frequently achieved (i.e., in 91.3% of cured acromegalic patients and in 91.0% of healthy subjects). Considering the whole cohort, the best combination of 2 time-points was +90’ and +150’ and achieved 95.6% accuracy; the best combination of 3 time-points was +60’, +90’ and +150’ and achieved 99.1% accuracy. The minimal subset of GH determinations that demonstrated perfect accuracy (100%) needed the inclusion of 4 time-points, namely +60’, +90’, +120’ and +150’.

Conclusion

A subset of 4 time-points (60’ – 90’ – 120’ – 150’) was identified as the most relevant to detect GH suppression at OGTT, with a perfect classification of 100% of subjects. This supports the possibility to restrict the blood samplings to these time-points when assessing disease cure, with possible advantages in terms of saving time and lowering costs.

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Availability of data and material

The datasets generated during and/or analyzed during the current study are not publicly available but are available from the corresponding author on reasonable request.

Code availability

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This research did not receive any specific grant.

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Authors and Affiliations

  1. Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy

    F. Bioletto, N. Prencipe, A. M. Berton, C. Bona, E. Varaldo, V. Gasco, E. Ghigo & S. Grottoli

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  1. F. Bioletto
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  2. N. Prencipe
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  3. A. M. Berton
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  4. C. Bona
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  5. E. Varaldo
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  6. V. Gasco
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  7. E. Ghigo
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  8. S. Grottoli
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Correspondence to F. Bioletto.

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Conflict of interest

Nunzia Prencipe and Silvia Grottoli are members of the Editorial Board of the Journal of Endocrinological Investigation; the other authors report no conflict of interest in this work.

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The study was approved by the local Ethics Committee (A.O.U. Città della Salute e della Scienza, Turin, Italy) and was in accordance with the principles of the Declaration of Helsinki.

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Bioletto, F., Prencipe, N., Berton, A.M. et al. Optimal timing of blood samplings to detect GH inhibition during oral glucose tolerance test. J Endocrinol Invest 45, 981–987 (2022). https://doi.org/10.1007/s40618-021-01731-0

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  • DOI: https://doi.org/10.1007/s40618-021-01731-0

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