Clinical indicators of biochemical remission in acromegaly: does incomplete disease control always mean therapeutic failure?

Damjanović, Svetozar; Nešković, Aleksandar N.; Petakov, Мilan; Popović, Vera; Macut, Djuro; Vukojevic, Pavle; Joksimović, Miloje

doi:10.1111/j.1365-2265.2005.02233.x

Cited by 25 publications

(28 citation statements)

References 79 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Although there have been many reports that these 2 biochemical markers do not always show compatible results, [18][19][20][21][22] both are essential in the determination of remission in acromegaly. A more specific parameter than random GH levels or 24-hour mean GH measurements, IGF-1 is especially useful in mild degrees of GH excess.…”

Section: Discussionmentioning

confidence: 95%

Predicting Long-term Remission by Measuring Immediate Postoperative Growth Hormone Levels and Oral Glucose Tolerance Test in Acromegaly

Kim¹,

Oh²,

Lee

et al. 2012

Neurosurgery

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 95%

Predicting Long-term Remission by Measuring Immediate Postoperative Growth Hormone Levels and Oral Glucose Tolerance Test in Acromegaly

Kim¹,

Oh²,

Lee

et al. 2012

Neurosurgery

View full text Add to dashboard Cite

show abstract

“…In general, the mortality rate of patients with DM or impaired glucose tolerance is significantly higher than in individuals with normal glucose tolerance [22] and its improvement or normalization in our patients may have contributed to their prolonged survival. Although our study did not evaluate its effect on cardiomegaly, in acromegalics, surgery has been reported to improve ventricular hypertrophy and cardiovascular functions [23,24]. According to Minniti et al 9 of their 11 surgically cured elderly acromegalics with left ventricular enlargement manifested postoperative normalization of the cardiac mass [4].…”

Section: Discussionmentioning

confidence: 99%

Treatment of Elderly Acromegalics

et al. 2008

View full text Add to dashboard Cite

Abstract. We assessed the incidence of elderly patients in Japanese acromegalics and the characteristics of their clinical presentation. We also evaluated the safety and efficacy of transsphenoidal surgery (TSS) in this patient group. During the 28-year period from 1980 to 2007 we treated 290 patients with acromegaly at our hospitals. Of these, 9 (3.1%) were elderly, i.e. 70 years old or older. They comprised 0.7% of acromegalics treated during the first-and 4.5% of patients with acromegaly treated during the 2nd 14-year period. Before treatment, all manifested abnormal glucose tolerance; 6 had diabetes mellitus (DM), 6 presented with hypertension, and 2 had cardiovascular disease, malignant neoplasms, or hyperlipidemia. Of the 7 elderly acromegalics who underwent TSS none manifested surgical morbidity or new pituitary hormone deficiencies. Postoperatively, the nadir growth hormone (GH) level at the oral glucose tolerance test (OGTT) was under 1.0 ng/mL in 5 patients, insulin-like growth factor (IGF-1) levels normalized in 4. Glucose tolerance improved in all operated patients. Only 1 of 6 patients with preoperatively diagnosed DM continued to manifest DM post-treatment, anti-hypertensive drugs could be tapered in 3 of patients with preoperative hypertension. In conclusion, we found that there was a high incidence of abnormal glucose tolerance and hypertension in elderly acromegalics, that surgical treatment was effective and safe in this population, and that it was useful for the control of co-morbidities.

show abstract

“…Leptin, the adipocyte-derived hormone is produced in proportion to fat stores. We have previously shown that leptin concentrations are higher in operated patients with acromegaly than in naive disease after adjustment for age, BMI and gender, suggesting that a rise in leptin levels might precede changes in body composition after successful transphenoidal surgery (33,34). Leptin concentrations in these studies were significantly higher in patients with cured acromegaly who were diagnosed as GH deficient compared with those cured but with normal GH secretory capacity.…”

Section: Discussionmentioning

confidence: 54%

Ghrelin test for the assessment of GH status in successfully treated patients with acromegaly

et al. 2006

View full text Add to dashboard Cite

Objective: Posttreatment assessment of disease activity and definition of cure of acromegaly, using measurement of GH secretion, remains problematic. Furthermore, with our efforts to achieve tight biochemical control of the disease it is foreseeable that a proportion of patients may be rendered GH deficient, thus requiring testing for GH deficiency. The aim of our study was to evaluate residual GH secretion in cured patients with acromegaly. Design and methods: At baseline, circulating GH, IGF-I, IGFBP-3, leptin and lipid (cholesterol and triglycerides) levels were measured in 33 acromegalic patients nine years after treatment with surgery of whom 6 were additionally irradiated. Two tests were performed: the GH suppression test -oral glucose tolerance test (OGTT) and the GH provocation test -ghrelin test (1 mg/kg i.v. bolus) and the results were compared with 11 age-and sex-matched control subjects. Results: According to the consensus criteria (normal IGF-I levels and post-OGTT GH nadir ,1 mg/l), 21 treated acromegalic patients were cured, 6 had discordant IGF-I and GH nadir values during OGTT, while 6 had persistent acromegaly. After the GH provocative test with ghrelin (cut-off for severe GH deficiency is GH , 3 mg/l), we detected 9 severely GH deficient patients (GHD) among 21 cured acromegalic patients. Mean GH peak (^S.E.M.) response to the ghrelin test in GHD acromegalics was significantly lower compared with acromegalics with sufficient GH secretory capacity and control subjects (1.2^0.2 mg/l vs 20.1^2.4 mg/l vs 31.1^2.5 mg/l respectively, P, 0.0001). Mean IGF-I and IGFBP-3 levels were not different between GHD and GH-sufficient cured acromegalics. Leptin levels and body mass index (BMI) were significantly higher in GHD male acromegalics compared with GH-sufficient male acromegalics. GHD female acromegalics tended to have higher BMIs while leptin levels were not different. Conclusions: The assessment of residual GH secretory capacity by the GH provocation test is necessary in the long-term follow-up of successfully treated acromegalics since a large proportion of these patients are rendered GH deficient.European Journal of Endocrinology 154 659-666

show abstract

Clinical indicators of biochemical remission in acromegaly: does incomplete disease control always mean therapeutic failure?

Cited by 25 publications

References 79 publications

Predicting Long-term Remission by Measuring Immediate Postoperative Growth Hormone Levels and Oral Glucose Tolerance Test in Acromegaly

Predicting Long-term Remission by Measuring Immediate Postoperative Growth Hormone Levels and Oral Glucose Tolerance Test in Acromegaly

Treatment of Elderly Acromegalics

Ghrelin test for the assessment of GH status in successfully treated patients with acromegaly

Contact Info

Product

Resources

About