Acromegaly and end-stage renal disease: A diagnostic challenge

Abstract

Chronic renal failure is associated with an impairment of the GH/IGF-I axis. We report the diagnostic challenges in a 72-yr-old female suffering from end-stage renal disease and presenting with clinical findings suggestive of acromegaly. GH was not suppressed during an oral glucose tolerance test, but rose paradoxically. However, serum IGF-I levels were within the normal range. IGF-binding proteins (IGFBP)-2 and -3 were markedly elevated and GH-binding protein (GHBP) was diminished. Clinical findings suspicious of acromegaly could be ascribed to pre-existing characteristics and consequences of end-stage renal disease. This suggested that the disturbances of the GH/IGF-I axis in our patient were due to chronic renal disease, rather than acromegaly. In the work-up for acromegaly, clinicians should be alerted to GH resistance in chronic renal failure.

High prevalence of biochemical acromegaly in primary care patients with elevated IGF‐1 levels

“…One patient had chronic kidney disease. Even though biochemical assessment of acromegaly is complicated by this fact, nonsupppressed GH secretion due to renal failure was always associated with low or normal, but not elevated IGF‐1 levels in the literature 9,10 to our knowledge.…”

Dynamic tests for the diagnosis and assessment of treatment efficacy in acromegaly

“…They found high or normal serum GH levels with a paradoxical rise in serum GH levels during OGTT, while IGF-1 levels were normal. These biological abnormalities were related to the renal disease and not to a somatotroph adenoma [34,35].…”