Three-hour spontaneous GH secretion profile is as reliable as oral glucose tolerance test for the diagnosis of acromegaly

Grottoli, Silvia; Razzore, Paola; Gaia, Daniela; Gasperi, Maurizio; Giusti, Massimo; Colao, Annamaria; Ciccarelli, Enrica; Gasco, Valentina; Martino, E.; Ghigo, Ezio; Camanni, F.

doi:10.1007/bf03345139

Cited by 26 publications

(18 citation statements)

References 32 publications

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“…In studies in which gender was taken into account [13,14], the upper normal limit of the GH nadir during the OGTT ranged between 0.057 and 0.25 lg/l in males and was 0.71 lg/l in females; note that the Immulite 2000 method gave two-fold higher concentrations than the Autodelfia method [14] in this range of GH values. Grottoli et al using a less sensitive method (detection limit 0.15 lg/l), found that the upper normal limit of the GH nadir during the OGTT was 0.7 lg/l, irrespective of gender [21,22]. In the oldest study included in Table 2 [23], based on an EIA, the GH level in one of the 37 healthy subjects remained above 1 lg/l after a glucose load.…”

Section: Dynamic Tests For Diagnosis Of Acromegalymentioning

confidence: 96%

Dynamic tests for the diagnosis and assessment of treatment efficacy in acromegaly

2008

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In the vast majority of cases, basal serum GH and IGF-1 levels are markedly increased in patients with obvious clinical signs and symptoms of acromegaly. The oral glucose tolerance test (OGTT) is useful for diagnosis in the minority of patients who have weak GH hypersecretion. The cutoff for a "normal" GH nadir in the OGTT remains to be agreed. The type of GH assay, its sensitivity, the type of standard used by the manufacturer, the patient's age and especially gender, must all be taken into account. Recent studies using new highly sensitive assays suggest an upper normal GH nadir of 0.71 microg/l for female healthy patients, but no "universal" cut-off has yet been defined for healthy males (from 0.057 to 0.25 microg/l). The 1 microg/l cutoff proposed for the diagnosis of acromegaly in a 2000 consensus should be abandoned in favor of a 0.30 microg/l cutoff. Clinicians should know which assay is used, together with its sensitivity and the standard, before making therapeutic decisions. A more pragmatic view should probably be adopted when assessing the treatment response. Indeed, if "cure" is defined not with the <1 microg/l GH nadir but on the basis of healthy control values, many patients will not be considered controlled. However, the clinical relevance of such goal (e.g. achieving GH nadir <0.4 microg/l rather than <1 microg/l) in terms of prognosis and prediction of outcome on long term is not firmly established. Thus, from a pragmatic point of view, achieving a normal age-adjusted IGF-1 level and a GH nadir below 1 microg/l during OGTT will probably remain relevant for defining remission and good disease control in terms of morbidity and mortality in acromegaly.

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Section: Dynamic Tests For Diagnosis Of Acromegalymentioning

confidence: 96%

Dynamic tests for the diagnosis and assessment of treatment efficacy in acromegaly

2008

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“…Since overt diabetes mellitus may limit the feasibility or reliability of the oral glucose-tolerance test for GH suppression, alternative testing such as thyrotrophin-releasing hormone stimulation may be indicated. There is also recent evidence than a 3-h GH profile may give results similar to oral glucose-tolerance test in acromegalics (33).…”

Section: Peculiarity Of Bioclinical Endocrine Changes In the Elderlymentioning

confidence: 97%

Diagnosis and management of pituitary tumours in the elderly: a review based on personal experience and evidence of literature

Minniti

Esposito

Piccirilli³

et al. 2005

eur j endocrinol

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An increasing proportion of pituitary adenomas are recognized in the elderly, raising the question of their optimal diagnosis and management. Age-related endocrine changes and associated diseases may significantly modify the clinical presentation and hormonal evaluation of these patients. About 80% of pituitary adenomas in this age group are non-secreting, requiring careful differential diagnosis with non-adenomatous sellar lesions. In this group, visual deterioration and hypopituitarism remain the leading symptoms. Recognized secreting tumours are mainly GH-secreting, most of them intrasellar, followed by prolactinomas, which present as clinically non-secreting and are usually invasive. Cushing's disease appears as a very rare eventuality in the elderly. Optimal therapeutic management should aim to control the disease while preserving or improving patient's quality of life. Transsphenoidal surgery has proved to be an efficient and well-tolerated option for non-secreting adenomas with visual defects and intrasellar GH-secreting adenomas, being able to improve metabolic and cardiovascular complications of acromegaly even in this age group. In contrast, dopamine-agonist drugs can be proposed as a primary therapy for prolactinomas even in the presence of severe neurological complications. Because the use of radiotherapy is hampered by its delay of action and potential neurological side effects, its indications should be better defined in this age group. The clinical importance of hypopituitarism should not be underestimated, and thyroid-and adrenal-replacement therapy are mandatory in the presence of documented hormone deficiency, carefully avoiding overtreatment in order to limit possible side effects on the cardiovascular system and bone mineralization. Indications for GH-and sex steroid-replacement therapy still await age-specific guidelines.European Journal of Endocrinology 153 723-735

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“…Of note, some authors have shown that the nadir GH levels obtained following glucose intake are not specific to glucose and also occur after water ingestion or even spontaneous GH measures. They showed that glucose rather inhibits spontaneous GH surges [17, 18]. The exact molecular mechanisms by which glucose modulates GH release are yet to be determined.…”

Section: Gh Response To Oral Glucose and To Chronic Hyperglycemiamentioning

confidence: 99%

Growth Hormone Response to Oral Glucose Load: From Normal to Pathological Conditions

Hage

Kamenický

Chanson³

2019

Neuroendocrinology

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The exact physiological basis of acute growth hormone (GH) suppression by oral glucose is not fully understood. Glucose-mediated increase in hypothalamic somatostatin seems to be the most plausible explanation. Attempts to better understand its underlying mechanisms are compromised by species disparities in the response of GH to glucose load. While in humans, glucose inhibits GH release, the acute elevation of circulating glucose levels in rats has either no effect on GH secretion or may be stimulatory. Likewise, chronic hyperglycemia alters GH release in both humans and rats nonetheless in opposite directions. Several factors influence nadir GH concentrations including, age, gender, body mass index, pubertal age, and the type of assay used. Besides the classical suppressive effects of glucose on GH release, a paradoxical GH increase to oral glucose may be observed in around one third of patients with acromegaly as well as in various other disorders. Though its pathophysiology is poorly characterized, an altered interplay between somatostatin and GH-releasing hormone has been suggested and a link with pituitary ectopic expression of glucose-dependent insulinotropic polypeptide receptor has been recently demonstrated. A better understanding of the dynamics mediating GH response to glucose may allow a more optimal use of the OGTT as a diagnostic tool in various conditions, especially acromegaly.

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Three-hour spontaneous GH secretion profile is as reliable as oral glucose tolerance test for the diagnosis of acromegaly

Cited by 26 publications

References 32 publications

Dynamic tests for the diagnosis and assessment of treatment efficacy in acromegaly

Dynamic tests for the diagnosis and assessment of treatment efficacy in acromegaly

Diagnosis and management of pituitary tumours in the elderly: a review based on personal experience and evidence of literature

Growth Hormone Response to Oral Glucose Load: From Normal to Pathological Conditions

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