Prevalence of discordant GH and IGF-I levels in acromegalics at diagnosis, after surgical treatment and during treatment with octreotide LAR.
BACKGROUND
Acromegalic patients are considered "discordant" if their insulin-like growth factor type I (IGF-I) levels are increased for their age with "safe" growth hormone (GH) levels or if their IGF-I levels are normal for their age with "unsafe" GH levels. The prevalence of discordance in acromegalics has been described to vary from 9.4% to 39%, and it may be observed at diagnosis or during the follow up.


OBJECTIVE
To evaluate the prevalence of discordant levels of IGF-I and GH in our acromegalic population.


METHODS
Hormonal evaluation was made with an oral glucose tolerance test (OGTT) with the IGF-I being assessed in the basal sample at diagnosis and after 3 months of the adenomectomy. During treatment with octreotide LAR, a GH curve (for the calculation of mean GH) and IGF-I assessment were made every 3 months.


RESULTS
Among the 51 patients evaluated at diagnosis, the prevalence of discordance was 13.7% (7/51). Among the 58 patients evaluated after the surgical procedure, eight (13.8%) had discordant GH and IGF-I levels. Among the 42 patients evaluated during treatment with octreotide LAR, the prevalence of discordant GH and IGF-I levels was 33.3% (14/42). Using 1 microg/L as a cut off level for "safe" GH, the prevalence of discordance was 3.9%, 8.6% and 28.6% at diagnosis, after surgery and during treatment with octreotide LAR, respectively. No difference of sex, age or treatment modality was observed among discordant and concordant patients with any GH cut off level.


CONCLUSIONS
We observed a prevalence of discordance similar to that previously described in the literature. We believe that studies evaluating morbidity and mortality in discordant patients are also necessary and will enlighten the true impact of this condition in the follow up of acromegaly.
Machado
Evelyn Oliveira
EO
Endocrinology Unit, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro (HUCFF-UFRJ), Rua Nascimento Silva, 555 apt: 101, CEP: 22421-020 Rio de Janeiro (RJ), Brazil.
Taboada
Giselle F
GF
Endocrinology Unit, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro (HUCFF-UFRJ), Rua Nascimento Silva, 555 apt: 101, CEP: 22421-020 Rio de Janeiro (RJ), Brazil.
Neto
Leonardo Vieira
LV
Endocrinology Unit, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro (HUCFF-UFRJ), Rua Nascimento Silva, 555 apt: 101, CEP: 22421-020 Rio de Janeiro (RJ), Brazil.
Haute
Flávia R van
FRV
Endocrinology Unit, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro (HUCFF-UFRJ), Rua Nascimento Silva, 555 apt: 101, CEP: 22421-020 Rio de Janeiro (RJ), Brazil.
Corrêa
Lívia L
LL
Endocrinology Unit, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro (HUCFF-UFRJ), Rua Nascimento Silva, 555 apt: 101, CEP: 22421-020 Rio de Janeiro (RJ), Brazil.
Balarini
Giovanna A
GA
Endocrinology Unit, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro (HUCFF-UFRJ), Rua Nascimento Silva, 555 apt: 101, CEP: 22421-020 Rio de Janeiro (RJ), Brazil; Diabetes Unit, Instituto Estadual de Diabetes e Endocrinologia Luiz Capriglione do Rio de Janeiro (IEDE-RJ), Brazil.
Shrank
Yolanda
Y
Diagnósticos da América (DASA), Medicina diagnóstica, Rio de Janeiro, Brazil.
Goulart
Marcio
M
Diagnósticos da América (DASA), Medicina diagnóstica, Rio de Janeiro, Brazil.
Gadelha
Mônica R
MR
Endocrinology Unit, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro (HUCFF-UFRJ), Rua Nascimento Silva, 555 apt: 101, CEP: 22421-020 Rio de Janeiro (RJ), Brazil; Endocrinology Unit, Instituto Estadual de Diabetes e Endocrinologia Luiz Capriglione do Rio de Janeiro (IEDE-RJ), Brazil.
D000172:Acromegaly / Q000175:diagnosis / Q000601:surgery / Q000628:therapy*; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D019382:Human Growth Hormone / Q000097:blood* / Q000378:metabolism; D006801:Humans; D007334:Insulin-Like Growth Factor I / Q000032:analysis* / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D015282:Octreotide / Q000008:administration & dosage / Q000627:therapeutic use*; D012189:Retrospective Studies; D016896:Treatment Outcome
D019382:Human Growth Hormone; D007334:Insulin-Like Growth Factor I; D015282:Octreotide