Monitoring disease activity using GH and IGF-I in the follow-up of 501 patients with acromegaly.
BACKGROUND
The aims of treatment in patients with acromegaly are to achieve serum GH/IGF-I concentrations associated with cure or normalization of mortality and alleviation of symptoms.


OBJECTIVE
Using the West Midlands Acromegaly database (n = 501) we investigated the reliability of basal fasting GH in predicting nadir or mean GH during oral glucose tolerance test (OGTT) or GH day curve (GHDC), respectively, the degree of discordance between disease activity measured by GH and IGF-I values and the effect of radiotherapy on the above relationships. In total 773 OGTT and 507 GHDC were performed.


RESULTS
Basal fasting GH was strongly correlated with nadir/mean GH on OGTT/GHDC (r = +0.87, P < 0.0001, r = +0.93, P < 0.0001, respectively). A basal GH < 2.5 microg/l was associated with a nadir/mean GH during OGTT/GHDC < 2.5 microg/l in 98.6% and 88.2% of cases, respectively. Elevated IGF-I was seen in 32.4% and 46.4% of patients with GH nadir values during OGTT < 1 and < 2.5 microg/l, respectively, and in 21.2% and 45.9% of GHDC with mean GH < 1 and < 2.5 microg/l, respectively. Radiotherapy increased the discordance in GH and IGF-I as markers of disease activity at GH < 2.5 microg/l (elevated IGF-I-values when OGTT nadir GH < 2.5 microg/l: radiotherapy 55.5%vs. no radiotherapy 36.9%, P = 0.002).


CONCLUSIONS
There is a close relationship between a basal fasting GH < 2.5 microg/l and nadir/mean GH < 2.5 microg/l during OGTT/GHDC. There is a large discordance between disease activity when assessed by GH and IGF-I which is further increased by radiotherapy. These observations illustrate the challenge of defining appropriate biochemical end-points to achieve control of disease and normalization of mortality in acromegaly.
Sherlock
M
M
Division of Medical Sciences, Centre for Endocrinology, Diabetes and Metabolism, University of Birmingham, Birmingham, UK.
Aragon Alonso
A
A
Reulen
R C
RC
Ayuk
J
J
Clayton
R N
RN
Holder
G
G
Sheppard
M C
MC
Bates
A
A
Stewart
P M
PM
D000172:Acromegaly / Q000175:diagnosis / Q000378:metabolism* / Q000628:therapy; D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D019382:Human Growth Hormone / Q000097:blood*; D006801:Humans; D007334:Insulin-Like Growth Factor I / Q000032:analysis* / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D016896:Treatment Outcome; D055815:Young Adult
D019382:Human Growth Hormone; D007334:Insulin-Like Growth Factor I