Prevalence of GH deficiency in cured acromegalic patients: impact of different previous treatments

Abstract

Objective: Radiotherapy (RT) for pituitary adenomas, including GH-secreting ones, frequently leads to GH deficiency (GHD). Data on the effects of surgery alone (S) on dynamic GH secretion are limited. The aim of the study was to investigate the occurrence of GHD in acromegalic patients treated with different therapeutic options. Design and methods: Fifty-six patients in remission from acromegaly, (33 F & 23 M, age: 54G13 years, body mass index (BMI): 28.4G4.1 kg/m 2 , 21 with adequately substituted pituitary deficiencies) treated by S alone (nZ33, group 1) or followed by RT (nZ23, group 2), were investigated for GHD by GHRH plus arginine testing, using BMI-adjusted cut-offs. Several metabolic and cardiovascular parameters (waist circumference, body fat percentage, blood pressure, fasting and post-oral glucose tolerance test glucose, HbA1c, insulin resistance and lipid profile) were evaluated in all the patients and 28 control subjects with known diagnosis of GHD. Results: Serum GH peak after challenge was 8.0G9.7 mg/l, without any correlation with post-glucose GH nadir and IGF-1 levels. The GH response indicated severe GHD in 34 patients (61%) and partial GHD in 15 patients (27%). IGF-1 were below the normal range in 14 patients (25%). The frequency of GHD was similar in the two treatment groups (54% in group 1 and 70% in group 2). No significant differences in metabolic parameters were observed between acromegalic patients and controls with GHD. Conclusions: Severe GHD may occur in about 60% of patients treated for acromegaly, even when cured after S alone. Thus, a stimulation test (i.e. GHRH plus arginine) is recommended in all cured acromegalic patients, independently from previous treatment.

GH deficiency in patients after cure of acromegaly by surgery alone

“…In contrast, our study is the first report demonstrating the frequency of sGHD evaluated by GHRP2 or GHRP2 plus arginine tests in a large number of cured patients fulfilling more stringent new criteria for cure of acromegaly. Compared with the report by Ronchi et al (9), sGHD was less common in our patients and was found only in 17 (9.1%) of the 186 patients. This lower percentage of sGHD in our patients may be due to different methods to evaluate sGHD.…”

“…Ronchi et al (9) first revealed the rate of sGHD after surgery as 54.5% in a relatively large number of patients (33 patients) by GHRH plus arginine tests. Those 33 patients were judged as cured based on the Cortina consensus criteria.…”

“…Our lower occurrence of hypopituitarism other than GHD (7/185, 3.8%) after successful surgery may also reflect this lower GHD occurrence rate, suggesting that less invasive selective adenomectomies were performed in those patients. Regarding possible prognostic factors, Ronchi et al (9) suggested that the presence of a macroadenoma and higher GH levels at the time of diagnosis together with the concomitant existence of other pituitary failures seemed to be the best candidates to predict GHD in patients successfully treated for acromegaly. Ronchi et al (9) also speculated that a more aggressive surgical approach, which is often necessary to cure larger GH-secreting adenomas, might increase the risk of further pituitary failures.…”

“…The result is that less attention is given to possible postoperative GH deficiency (GHD). Indeed, there have been few reports on GHD after radiotherapy for acromegaly (3)(4)(5)(6) and there have only been few and contradictory studies conducted on small numbers of patients of GHD after TSS alone (7)(8)(9)(10). Therefore, a large number of patients undergoing surgery who were later deemed cured by the recent stringent criteria for cure of acromegaly were studied to determine the characteristics of GH-deficient patients with prior acromegaly.…”

Effect of long-term GH replacement therapy on cardiovascular outcomes in GH-deficient patients previously treated for acromegaly: a sub-analysis from the Dutch National Registry of Growth Hormone Treatment in Adults

“…Transsphenoidal surgery is the treatment of choice for intrasellar microadenomas, noninvasive macroadenomas, and when the tumor is causing compression symptoms on the surrounding tissues (4,5). Surgery or radiotherapy as treatment modalities may be burdened by a great prevalence of pituitary hormone deficiencies, including GH deficiency (GHD) (6). Ronchi et al (6) stated that the prevalence of severe GHD is 60% in patients treated for acromegaly by surgery alone or surgery followed by radiotherapy.…”