Management policy for postoperative acromegaly patients with normal IGF-1 and high GH levels on oral glucose tests.

Autor: Kinoshita Y; Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan. y-kinoshita@hiroshima-u.ac.jp., Taguchi A; Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan., Yamasaki F; Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan., Onishi S; Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan., Tominaga A; Department of Neurosurgery and Neuro-Endovascular Therapy, Hiroshima Prefectural Hospital, 1-5-54 Ujinakanda, Minami-ku, Hiroshima, 734-8530, Japan., Horie N; Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
Jazyk: angličtina
Zdroj: Pituitary [Pituitary] 2024 Dec 26; Vol. 28 (1), pp. 4. Date of Electronic Publication: 2024 Dec 26.
DOI: 10.1007/s11102-024-01487-9
Abstrakt: Purpose: Acromegaly patients occasionally achieve either of the remission criterion of IGF-1 or GH level postoperatively; however, treatment for patients with discordant IGF-1 and GH levels remains unclear. This study aimed to clarify the clinical courses and features of postoperative patients with normal IGF-1 and high GH levels and support their management.
Methods: Overall, 110 acromegaly patients underwent initial surgery and a 75-g oral glucose tolerance test (OGTT) 3 months postoperatively. Of the 110, 23 patients with normal IGF-1 and nadir GH levels of ≥ 0.4 µg/L on OGTT (high-GH group) were categorized into three subtypes based on their repeated examinations thereafter: late-remission type (nadir GH level on OGTT of < 0.4 µg/L later), recurrence type (elevated IGF-1 and GH levels later), and persistent type (normal IGF-1 levels and constantly high nadir GH levels on OGTTs).
Results: Proportion of patients in the high-GH group was 23.6%, and they were distributed as follows: late-remission type (n = 10), recurrence type (n = 5), and persistent type (n = 8). There were significantly more women (P = 0.0178) than men in the late-remission type, and patients in the persistent type had significantly larger tumors (P = 0.0110) and higher preoperative GH levels (P = 0.0018) than those that achieved complete remission 3 months postoperatively.
Conclusion: Careful monitoring without additional medications is recommended at first in acromegaly patients with normal IGF-1 and high GH levels considering the possibility of recurrence in the future.
Competing Interests: Declarations. Conflicts of interest/Competing interests: The authors declare no conflict of interest in association with the present study. Ethics approval: This study was approved by the Ethical Committee for Epidemiology of Hiroshima University (E-2020-2022-02). Disclosure statement: The contents of this manuscript have not been published in full elsewhere in any form.
(© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
Databáze: MEDLINE
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