Acromegaly and end-stage renal disease: a diagnostic challenge.
Chronic renal failure is associated with an impairment of the GH/IGF-I axis. We report the diagnostic challenges in a 72-yr-old female suffering from end-stage renal disease and presenting with clinical findings suggestive of acromegaly. GH was not suppressed during an oral glucose tolerance test, but rose paradoxically. However, serum IGF-I levels were within the normal range. IGF-binding proteins (IGFBP)-2 and -3 were markedly elevated and GH-binding protein (GHBP) was diminished. Clinical findings suspicious of acromegaly could be ascribed to pre-existing characteristics and consequences of end-stage renal disease. This suggested that the disturbances of the GH/IGF-I axis in our patient were due to chronic renal disease, rather than acromegaly. In the work-up for acromegaly, clinicians should be alerted to GH resistance in chronic renal failure.
Müssig
K
K
Division of Endocrinology, Metabolism, and Pathobiochemistry, Department of Internal Medicine, University Hospital of Tubingen, Tubingen, Germany. Karsten.Muessig@med.uni-tuebingen.de
Gallwitz
B
B
Ranke
M B
MB
Horger
M
M
Häring
H U
HU
Quabbe
H J
HJ
D000172:Acromegaly / Q000097:blood / Q000175:diagnosis*; D000368:Aged; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood / Q000175:diagnosis*