Conventional Pituitary Irradiation Is Effective in Lowering Serum Growth Hormone and Insulin-Like Growth Factor-I in Patients with Acromegaly

Jenkins, P; Bates, P. R.; Carson, Maggie; Stewart, PM; Wass, J. A. H.

doi:10.1210/jc.2005-1616

Cited by 205 publications

(126 citation statements)

References 39 publications

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“…A recent report of the UK National Acromegaly Register Study Group has also demonstrated that significant numbers of patients have normal IGF1 levels after irradiation though in that series the length of time off adjunctive treatment was not specified (18). Our results are complimentary to these and have the advantage of being in one centre with a single laboratory, clinic and radiation site, albeit with two irradiation schedules and three IGF1 assays over the 40 years.…”

Section: Discussionsupporting

confidence: 63%

“…The effect of EPI in normalising serum IGF1 levels has been a cause of dispute (14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)30) (Table 1). Barkan et al reported that following radiotherapy for acromegaly only 2 out of 38 patients (5%) taken off medical therapy for 2-3 weeks normalized IGF1 over 10 years despite attenuation of GH levels (14).…”

Section: Introductionmentioning

confidence: 99%

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Long term effect of external pituitary irradiation on IGF1 levels in patients with acromegaly free of adjunctive treatment

Mullan¹,

Sanabria²,

Abram³

et al. 2009

European Journal of Endocrinology

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Objective: It is established that external pituitary irradiation (EPI) effectively reduces serum GH levels in acromegaly. However, its effect in normalising serum IGF1 has been disputed. We looked at the number of our patients who achieved persistently normal IGF1 levels whilst free of adjunctive treatment for at least 1 year after EPI. Patients and design: We identified 63 acromegalic patients between 1964 and 2004 who received EPI. Six were excluded: three had surgery after EPI, two had no medical records available, and one had a pituitary Yttrium implant. Measurements: Patients received 4500-5000 cGy in fractionated doses. IGF1 levels were correlated with their respective age-related reference ranges. Results: After EPI, the number of patients with normal IGF1 and free of adjunctive medical treatment for at least 1 year were four patients by 3 years, nine patients by 5 years and seventeen by 10 years, with the current number of 25/57 (44%). Concordance between IGF1 levels and random GH dropped from 90% at the time of EPI to 65% at 3 years, 66% at 5 years and 71% at 10 years. Conclusions: We have demonstrated that, with time, EPI achieves a normal IGF1 in significant numbers of patients with acromegaly, thus obviating the need for life-long expensive medical therapy. For each patient this benefit has to be weighed against the possibility of new hypopituitarism as a result of the treatment. Any decision to use EPI is easier in the context of pre-existent hypopituitarism.

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Section: Discussionsupporting

confidence: 63%

Section: Introductionmentioning

confidence: 99%

Long term effect of external pituitary irradiation on IGF1 levels in patients with acromegaly free of adjunctive treatment

Mullan¹,

Sanabria²,

Abram³

et al. 2009

European Journal of Endocrinology

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“…RT is effective in lowering serum GH and IGF1 concentrations in patients with acromegaly, with biochemical control of the disease being achieved in 60% of patients within 10 years after irradiation (3).…”

Section: Introductionmentioning

confidence: 99%

Quality of life is impaired in association with the need for prolonged postoperative therapy by somatostatin analogs in patients with acromegaly

Postma

Netea‐Maier²,

Berg³

et al. 2012

European Journal of Endocrinology

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Objective: To assess the influence of long-acting somatostatin analogs (SSTA) after initial pituitary surgery on long-term health-related quality of life (HR-QoL) in relation to disease control in patients with acromegaly. Design: This is a cross-sectional study in two tertiary referral centers in The Netherlands. Patients and methods: One hundred and eight patients with acromegaly, in whom transsphenoidal (nZ101, 94%) or transcranial (nZ7, 6%) surgery was performed. Subsequently, 46 (43%) received additional radiotherapy and 41 (38%) were on postoperative treatment with SSTA because of persistent or recurrent disease at the time of study. All subjects filled in standardized questionnaires measuring HR-QoL. Disease control at the time of study was assessed by local IGF1 SDS. Results: IGF1 SDS were slightly higher in patients treated with SSTA in comparison with patients without use of SSTA (0.85G1.52 vs 0.25G1.21, PZ0.026), but the percentage of patients with insufficient control (IGF1 SDS O2) was not different (17 vs 9%, PZ0.208). Patients using SSTA reported poorer scores on most subscales of the RAND-36 and the acromegaly QoL and on all subscales of the multidimensional fatigue inventory-20. A subgroup analysis in patients with similar IGF1 levels (SSTAC, nZ26, IGF1 SDS 0.44G0.72 vs SSTAK, nZ44, IGF1 SDS 0.41G0.65) revealed worse scores on physical functioning, physical fatigue, reduced activity, vitality, and general health perception across all HR-QoL questionnaires in patients treated with SSTA. Conclusion: QoL is impaired in association with the need for prolonged postoperative therapy by SSTA in patients with acromegaly despite similar IGF1 levels.

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“…In humans suffering from acromegaly, IGF‐1 concentrations attenuate very slowly after RT and maximal control of the release of GH may require more than 15 years. Radiotherapy is therefore generally reserved for tumors that have recurred or persisted after surgery 21. On the other hand, successful hypophysectomy leads to an immediate reduction in GH and IGF‐1 and both parameters are therefore used to assess biochemical control of disease, as well as predict the risk of recurrence 22.…”

Section: Discussionmentioning

confidence: 99%

Evaluation and Diagnostic Potential of Serum Ghrelin in Feline Hypersomatotropism and Diabetes Mellitus

Jensen

Forcada

Church

et al. 2015

Veterinary Internal Medicne

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BackgroundGhrelin is a growth hormone secretagogue. It is a potent regulator of energy homeostasis. Ghrelin concentration is down‐regulated in humans with hypersomatotropism (HS) and increases after successful treatment. Additionally, ghrelin secretion seems impaired in human diabetes mellitus (DM).HypothesisSerum ghrelin concentration is down‐regulated in cats with HS‐induced DM (HSDM) compared to healthy control cats or cats with DM unrelated to HS and increases after radiotherapy.AnimalsCats with DM (n = 20) and with HSDM (n = 32), 13 of which underwent radiotherapy (RT‐group); age‐matched controls (n = 20).MethodsRetrospective cross‐sectional study. Analytical performance of a serum total ghrelin ELISA was assessed and validated for use in cats. Differences in serum ghrelin, fructosamine, IGF‐1 and insulin were evaluated.ResultsGhrelin was significantly higher (P < .001) in control cats (mean ± SD: 12.9 ± 6.8 ng/mL) compared to HSDM‐ (7.9 ± 3.3 ng/mL) and DM‐cats (6.7 ± 2.3 ng/mL), although not different between the HSDM‐ and DM‐cats. After RT ghrelin increased significantly (P = .003) in HSDM‐cats undergoing RT (from 6.6 ± 1.9 ng/mL to 9.0 ± 2.2 ng/mL) and the after RT ghrelin concentrations of HSDM cats were no longer significantly different from the serum ghrelin concentration of control cats. Serum IGF‐1 did not significantly change in HSDM‐cats after RT, despite significant decreases in fructosamine and insulin dose.Conclusion and Clinical ImportanceGhrelin appears suppressed in cats with DM and HSDM, although increases after RT in HSDM, suggesting possible presence of a direct or indirect negative feedback system between growth hormone and ghrelin. Serum ghrelin might therefore represent a marker of treatment effect.

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Conventional Pituitary Irradiation Is Effective in Lowering Serum Growth Hormone and Insulin-Like Growth Factor-I in Patients with Acromegaly

Abstract: In this, the largest series reported, conventional pituitary irradiation is shown to be an effective and safe means of reducing both serum GH and IGF-I concentrations in patients with acromegaly.

Cited by 205 publications

References 39 publications

Long term effect of external pituitary irradiation on IGF1 levels in patients with acromegaly free of adjunctive treatment

Long term effect of external pituitary irradiation on IGF1 levels in patients with acromegaly free of adjunctive treatment

Quality of life is impaired in association with the need for prolonged postoperative therapy by somatostatin analogs in patients with acromegaly

Evaluation and Diagnostic Potential of Serum Ghrelin in Feline Hypersomatotropism and Diabetes Mellitus

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