Mean GH profile is more accurate than single fasting GH in the evaluation of acromegaly disease control during somatostatin receptor ligands therapy

Abstract

Purpose This study aims to compare the accuracy of mean GH profile (GHP) < 2.5 ng/ml and single fasting GH (SGH) < 1 ng/ml in the evaluation of disease control in acromegaly patients during somatostatin receptor ligands (SRLs) therapy. Methods We retrospectively enrolled 100 acromegaly patients, 68 responder, and 32 partial responder to SRLs. Controlled disease has been defined as IGF-I levels within age-related normal limits, while partial response as pathological IGF-I values despite a reduction ≥ 50%. In all patients, GHP, SGH, IGF-I, and IGFBP-3 were evaluated. Results Median GHP levels (1.2 ng/ml, IQR 0.5–2.3 ng/ml) were lower (p = 0.001) than SGH (1.9 ng/ml, IQR 1.0–3.6 ng/ml). Accuracy of GHP was 81%, whereas that of SGH was 55%, with a Kappa index of 0.520 and 0.237, respectively. In multivariable analysis GHP (p = 0.002) and IGFBP-3 (p = 0.004), but not SGH, were independently associated with normal IGF-I levels. At receiver–operator characteristic curve (ROC) analysis GHP cut-off sensitivity and specificity were 94.1% and 50.0%, respectively, while SGH sensitivity and specificity were 35.3% and 93.7%, respectively. Finally, in obese patients the GH cut-off level (both as SGH and GHP) associated to good disease control was significantly different with respect to not obese ones. Conclusions GHP associates with IGF-I (and therefore with appropriate control of disease) with higher accuracy than SGH. When GH evaluation is needed, the measurement of mean GHP should be preferred and use of BMI-related cut-offs is suggested.

Discordant biochemical parameters of acromegaly remission do not influence the prevalence or aggressiveness of metabolic comorbidities: a single-center study

“…Similarly, Bona et al. ( 23 ) showed that the accuracy of the mean GH profile, associated with IGF-1, is higher than a single fasting GH measurement.…”

Serum Phosphorus and Calcium as Biomarkers of Disease Status in Acromegaly

“…Nadir GH was measured after a 75 g glucose tolerance test. In diabetic patients and/or those treated with somatostatin analogs (SSA), serum GH levels were determined every 30 min, and the arithmetical mean was counted based on five measurements [18,19,23,24]. All patients underwent an MRI scan (or CT, in case of contraindications) of the pituitary gland to determine image characteristics: tumor size, intratumor hemorrhage, and invasion type.…”

“…Nadir GH above 1 ng/mL in 75 g oral glucose tolerance test (patients without diabetes) or random GH levels above 2.5 ng/mL (mean of five measurements repeated every 30 min-in patients with diabetes) [18,19,23,24].…”

“…(C) Remission was defined as age-normalization of IGF-1 and normalization of GH (GH < 1 ng/mL in 75 g OGTT or random GH < 2.5 ng/mL in diabetic patients) [18,19,23,24].…”

Using 2-dimensional hand photographs to predict postoperative biochemical remission in acromegaly patients: a transfer learning approach

“…Surgical treatment can effectively lead to biochemical control. Furthermore, baseline characteristics that can impact long-term outcomes include age at diagnosis ( 7 ), gender ( 7 ), preoperative serum levels of GH and IGF-1 ( 8 - 13 ), preoperative medication ( 12 ), tumor size ( 8 , 9 , 12 ), invasiveness ( 12 , 14 ), Knosp grading scores ( 8 , 9 , 12 ), and histological pathology [Ki-67, somatostatin receptor subtype 2 expression, arylhydrocarbon receptor inter acting protein (AIP) expression, and granularity] ( 14 ). Therefore, identifying independent factors that predict long-term outcomes, such as biochemical remission or recurrence, may be crucial in facilitating clinical management.…”