Age changes the diagnostic accuracy of mean profile and nadir growth hormone levels after oral glucose in postoperative patients with acromegaly.
BACKGROUND
This analytical, retrospective study was designed to select cut-off thresholds of mean GH levels during a diurnal profile and nadir GH levels after oral glucose tolerance test (OGTT) according to age to diagnose surgical remission of acromegaly.


METHODS
One hundred forty-one patients (76 women, aged 44 +/- 15 years and 65 men, aged 43 +/- 13 years) were included in this study. For the purpose of this study, remission was based on insulin-like growth factor-I (IGF-I) levels in the normal range for age. Diagnostic accuracy was analysed by receiving-operator characteristics (ROC) curves in the entire series, and in young (20-40 years), middle-aged (41-60 years) and older patients (> 60 years), separately.


RESULTS
Sixty patients (42.6%) had normal IGF-I levels after surgery. In the entire series, in young and in middle-aged patients, the ROC analysis showed that optimum cut-off for mean GH levels was 2.3 microg/l (diagnostic accuracy range, 94-97%) whereas that for nadir GH after OGTT were, respectively, 0.85, 0.9 and 0.8 microg/l (diagnostic accuracy range, 90-95%). In the older patients, the optimum cut-off selected for mean GH levels was 1.4 microg/l and that for nadir GH after OGTT was 0.5 microg/l (diagnostic accuracy, 100% for both). The comparative analysis of the ROC curves did not show any significant difference between mean GH and nadir GH after OGTT (P = 0.21).


CONCLUSIONS
The criteria currently accepted for diagnosing post-surgical remission of acromegaly have high diagnostic accuracy only in the patients aged below 60 years. In older patients, lower cut-offs (i.e. = 1.4 microg/l for fasting GH and = 0.5 microg/l for nadir GH after OGTT) predict normal IGF-I levels. Mean GH levels during a diurnal profile have similar diagnostic accuracy of nadir GH levels after OGTT. This suggests that OGTT is not necessary to establish surgical cure.
Colao
Annamaria
A
Department of Molecular and Clinical Endocrinology and Oncology, Section of Endocrinology, University Federico II of Naples, Naples, Italy. colao@unina.it
Pivonello
Rosario
R
Cavallo
Luigi M
LM
Gaccione
Maria
M
Auriemma
Renata S
RS
Esposito
Felice
F
Cappabianca
Paolo
P
Lombardi
Gaetano
G
D000172:Acromegaly / Q000097:blood / Q000175:diagnosis* / Q000601:surgery; D000328:Adult; D000367:Age Factors; D000368:Aged; D005260:Female; D005947:Glucose; D005951:Glucose Tolerance Test; D013006:Growth Hormone / Q000097:blood* / Q000378:metabolism; D006801:Humans; D007334:Insulin-Like Growth Factor I / Q000032:analysis; D008297:Male; D008875:Middle Aged; D010911:Pituitary Neoplasms / Q000378:metabolism / Q000601:surgery; D011184:Postoperative Period; D015175:Prolactinoma / Q000601:surgery; D012372:ROC Curve; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D018709:Statistics, Nonparametric; D016896:Treatment Outcome
D007334:Insulin-Like Growth Factor I; D013006:Growth Hormone; D005947:Glucose