The Biochemical Diagnosis of Acromegaly

Akirov, Amit; Masri-Iraqi, Hiba; Dotan, Idit; Shimon, Ilan

doi:10.3390/jcm10051147

Cited by 19 publications

(22 citation statements)

References 43 publications

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“…Although NLR, PLR, and SII values were significantly higher in acromegaly than in NFPAs, these inflammatory indices cannot be used to discriminate GH-secreting pituitary tumors from NFPAs due to very low diagnostic accuracy. A ROC curve analysis confirmed that traditional markers of acromegaly, such as GH/IGF-1 showed the best sensitivity and specificity ranged from 92-100% and 89-100% respectively, which is consistent with literature data [4].…”

Section: Discussionsupporting

confidence: 89%

“…GH-secreting pituitary tumors are characterized by a benign nature and follow an indolent course [1]. Initially, the clinical features of acromegaly may be very subtle, which most likely results in a prolonged diagnostic delay of an average of 5 to 10 years after the onset of first signs and symptoms [4]. It is well established that long-lasting GH/IGF-1 axis hypersecretion leads to a number of systemic complications, especially increased risk of cardiovascular diseases that reduce the patient's quality of life and survival [5].…”

Section: Introductionmentioning

confidence: 99%

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Neutrophil-to-Lymphocyte, Platelet-to-Lymphocyte Ratios, and Systemic Immune-Inflammation Index as Potential Biomarkers of Chronic Inflammation in Patients with Newly Diagnosed Acromegaly: A Single-Centre Study

Szydełko

Szydełko-Gorzkowicz

Matyjaszek‐Matuszek

2021

JCM

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Acromegaly is a rare disease caused by overproduction of growth hormone (GH) by a pituitary adenoma, and consequently increased insulin-like growth factor 1 (IGF-1) concentration. The GH/IGF-1 axis and immune cells interactions are hypothesized to be involved in subclinical inflammation. This retrospective study aimed to investigate the differences in neutrophil-to-lymphocyte (NLR), platelet-to-lymphocyte (PLR) ratios, and systemic immune-inflammation index (SII) in GH-secreting adenomas compared with non-functioning pituitary adenomas (NFPAs) concerning clinical and radiological findings. After evaluation of 665 patients with pituitary tumors, 62 individuals with newly diagnosed acromegaly and 134 with NFPAs were enrolled in the analysis. The control group consisted of 120 healthy individuals. Fifty-eight patients with acromegaly were re-evaluated after medical or surgical therapies. NLR, PLR, SII values, and neutrophil count were significantly higher (p ≤ 0.001), whereas lymphocyte count was lower in acromegaly than in NFPAs (p = 0.001). No significant differences between NFPAs and controls were observed in analyzed ratios. Higher preoperative NLR, PLR, SII values were found in patients who failed to achieve a cure with surgery (p < 0.05). Although NLR, PLR, and SII values were significantly higher in acromegaly, these indices cannot be used to discriminate GH-secreting pituitary tumors from NFPAs. Treatment of acromegaly decreased the value of NLR and SII, but it requires further studies to consolidate the real clinical role of these inflammation-related ratios.

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Section: Discussionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Neutrophil-to-Lymphocyte, Platelet-to-Lymphocyte Ratios, and Systemic Immune-Inflammation Index as Potential Biomarkers of Chronic Inflammation in Patients with Newly Diagnosed Acromegaly: A Single-Centre Study

Szydełko

Szydełko-Gorzkowicz

Matyjaszek‐Matuszek

2021

JCM

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“…acromegaly). After an oral glucose tolerance test of 75 mg GH suppressed to a nadir GH of 0.73 μg/L, above the level suggested by some authors as a sensitive value to diagnose acromegaly (GH nadir of <0.4 μg/L ( 2 )) but below the level suggested by the 2014 Endocrine Society Clinical Practice Guidelines of GH nadir of <1 μg/L ( 3 ).…”

Section: Investigationmentioning

confidence: 74%

Unilateral hydrocephalus from a gangliocytoma-somatotrophinoma: first reported case

Ryder

Robusto

Robertson

et al. 2021

Endocrinology, Diabetes &Amp; Metabolism Case Reports

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Summary Although pituitary macroadenomas often cause mass effects on surrounding structures, it is extremely rare for pituitary lesions to disturb cerebrospinal fluid circulation. Sellar gangliocytoma-pituitary adenomas (SGPAs) are also extremely rare. Here we report the unique case of a man with the unusual combination of acromegaly from an SGPA, who presented with unilateral hydrocephalus. A 60-year-old man presented with rapid neurological deterioration, bitemporal hemianopia, and acromegalic features. Neuroimaging revealed a large sellar lesion extending superiorly into the left foramen of Monro, causing acute obstructive unilateral hydrocephalus. External ventricular drain placement improved consciousness immediately. Biochemical assessment confirmed acromegaly. Following trans-sphenoidal debulking, histology revealed a mixed gangliocytoma/sparsely-granulated somatotrophinoma. Despite the residual disease, his vision recovered remarkably, low-dose cabergoline controlled residual excess growth hormone (GH) secretion, and the residual tumour has remained extremely stable over 2 years. Hydrocephalus is an extremely rare complication of pituitary lesions, and unilateral hydrocephalus has never been reported previously. GH secretion in SGPAs is more common than for pituitary adenomas in general, raising questions regarding the aetiology and therapeutic approach to this rare combination tumour. Learning points Pituitary tumours most commonly present with symptoms related to endocrine disturbance or mass effects upon visual pathways (e.g. optic chiasm, nerves in the lateral cavernous sinus). However, extremely rarely, pituitary masses may disrupt cerebrospinal fluid (CSF) circulation resulting in hydrocephalus. Sellar gangliocytomas are very rare tumours and most of them are hybrid tumours with pituitary adenomas (SGPAs). SGPAs are typically indolent and may be functioning or non-functioning tumours. Growth hormone (GH)-producing SGPAs are less likely to respond to somatostatin agonists than classic somatotrophinomas. Primary surgical debulking via a trans-sphenoidal approach was effective in this individual, leading to the restoration of CSF circulation and improvement in visual disturbance, while also negating the need for permanent CSF diversion despite the residual tumour burden.

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“…Our patient's presentation of headache may be multifactorial including a possible initial pituitary adenoma, an ES, or directly from an elevated GH level. Ectopic acromegaly occurs due to the secretion of GHRH or rarely GH from extra-pituitary tumors (24). When compared to a pituitary cause of acromegaly where GHRH levels may be normal or more often suppressed, in the case of ectopic GHRH secretion, serum GHRH levels are raised (25,26,27).…”

Section: Discussionmentioning

confidence: 99%

“…Ectopic acromegaly occurs due to the secretion of GHRH or rarely GH from extra-pituitary tumors ( 24 ). When compared to a pituitary cause of acromegaly where GHRH levels may be normal or more often suppressed, in the case of ectopic GHRH secretion, serum GHRH levels are raised ( 25 , 26 , 27 ).…”

Section: Discussionmentioning

confidence: 99%

Acromegaly with empty sella syndrome

Daya

Seedat

Purbhoo

et al. 2021

Endocrinology, Diabetes &Amp; Metabolism Case Reports

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Summary Acromegaly is a rare, chronic progressive disorder with characteristic clinical features caused by persistent hypersecretion of growth hormone (GH), mostly from a pituitary adenoma (95%). Occasionally, ectopic production of GH or growth hormone-releasing hormone (GHRH) with resultant GH hypersecretion may lead to acromegaly. Sometimes localizing the source of GH hypersecretion may prove difficult. Rarely, acromegaly has been found in patients with an empty sella (ES) secondary to prior pituitary radiation and/or surgery. However, acromegaly in patients with primary empty sella (PES) is exceeding rarely and has only been described in a few cases. We describe a 47-year-old male who presented with overt features of acromegaly (macroglossia, prognathism, increased hand and feet size). Biochemically, both the serum GH (21.6 μg/L) and insulin-like growth factor 1 (635 μg/L) were elevated. In addition, there was a paradoxical elevation of GH following a 75 g oral glucose load. Pituitary MRI demonstrated an ES. In order to exclude an ectopic source of GH hypersecretion, further biochemical tests and imaging were done, which were unremarkable. Notably, increased uptake in the sella turcica on the 68Gallium DOTATATE PET/CT confirmed the ES as the likely source of GH secretion. As no overt lesion was noted, medical treatment (octreotide acetate) was initiated with a good clinical and biochemical response. At his 3 month follow-up, he reported an improvement in symptoms (fatigue and headache), however he still complained of low libido. Due to a persistently low testosterone level at follow-up, a long-acting testosterone was initiated. His GH level normalised, and IGF-1 has significantly reduced. Learning points The commonest cause of acromegaly is due to GH hypersecretion from pituitary adenomas (95%). Acromegaly has rarely been found in patients with ES. It is important to exclude a past history suggestive of pituitary apoplexy. Extra-pituitary source of GH such as ectopic production of GHRH with resultant GH hypersecretion needs to be excluded. In such cases, since there is no resectable mass, medical therapy is the primary treatment option.

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The Biochemical Diagnosis of Acromegaly

Cited by 19 publications

References 43 publications

Neutrophil-to-Lymphocyte, Platelet-to-Lymphocyte Ratios, and Systemic Immune-Inflammation Index as Potential Biomarkers of Chronic Inflammation in Patients with Newly Diagnosed Acromegaly: A Single-Centre Study

Neutrophil-to-Lymphocyte, Platelet-to-Lymphocyte Ratios, and Systemic Immune-Inflammation Index as Potential Biomarkers of Chronic Inflammation in Patients with Newly Diagnosed Acromegaly: A Single-Centre Study

Unilateral hydrocephalus from a gangliocytoma-somatotrophinoma: first reported case

Acromegaly with empty sella syndrome

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