title: Clinical and metabolic characteristics of acromegalic patients with high IGF1/normal GH levels during somatostatin analog treatment.
abstract: BACKGROUND
  Divergence between GH and IGF1 values are often reported in treated acromegalic patients, but the mechanisms of this discrepancy have not been completely explored.
  
  
  OBJECTIVE
  To evaluate the frequency of divergence between GH and IGF1 values and identify the role of clinical and metabolic factors in treated patients with acromegaly, according to the latest criteria of Cure published in July 2010.
  
  
  METHODS
  Retrospective study of patients' records between October 2002 and March 2008. Patients were grouped according to their mean GH and IGF1 values as 'controlled' (normal GH and IGF1), 'divergent' (high IGF1 and normal GH) and 'uncontrolled' (high GH and IGF1), and compared with respect to their clinical characteristics and metabolic markers.
  
  
  RESULTS
  Patients (n=104) were grouped as 'controlled' (n=20), 'divergent' (n=43) and 'uncontrolled' (n=41). More patients in the divergent group (93%) and uncontrolled group (98%) were treated with somatostatin analogs than in the controlled group (65%; P=0.001 for the comparison of the three groups). Patients in the divergent group had higher fasting blood glucose (0.94 g/l (interquartile range: 0.83-1.17)) and systolic blood pressure (130 mmHg (120-140) compared with the controlled group (0.84 g/l (0.80-0.92); P=0.017) and 120 mmHg (interquartile range: 110-130; P=0.029). In patients with divergent IGF1/GH levels, fasting glucose and GH were both strongly associated with IGF1.
  
  
  CONCLUSIONS
  Totally 41% of treated acromegalic patients had a high IGF1 and normal GH level. In these divergent patients treated with somatostatin analogs, these clinical and metabolic parameters might either play a causal role or be a marker for disease activity.
authors.affiliation: Department of Endocrinology and Metabolic Diseases, Pôle Cardio-vasculaire et Métabolique, CHU Rangueil-Larrey, 24 Chemin de Pourvouville, TSA 30030, 31059 Toulouse Cedex 9, France.
authors.forename: Maria
authors.initials: M
authors.lastname: Matta
authors.forename: Vanina
authors.initials: V
authors.lastname: Bongard
authors.forename: Solange
authors.initials: S
authors.lastname: Grunenwald
authors.forename: Jean-Christophe
authors.initials: JC
authors.lastname: Maiza
authors.forename: Antoine
authors.initials: A
authors.lastname: Bennet
authors.forename: Philippe
authors.initials: P
authors.lastname: Caron
mesh_terms: D000172:Acromegaly / Q000188:drug therapy / Q000378:metabolism* / Q000473:pathology*; D000328:Adult; D000368:Aged; D000375:Aging / Q000502:physiology; D001786:Blood Glucose / Q000378:metabolism; D001794:Blood Pressure / Q000502:physiology; D001827:Body Height / Q000187:drug effects; D015992:Body Mass Index; D005260:Female; D006727:Hormone Antagonists / Q000627:therapeutic use*; D019382:Human Growth Hormone / Q000097:blood*; D006801:Humans; D007334:Insulin-Like Growth Factor I / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D012189:Retrospective Studies; D012744:Sex Ratio; D013004:Somatostatin / Q000031:analogs & derivatives* / Q000627:therapeutic use*
chemical_list: D001786:Blood Glucose; D006727:Hormone Antagonists; D019382:Human Growth Hormone; D013004:Somatostatin; D007334:Insulin-Like Growth Factor I