Body mass index and insulin-like growth factor 1 as risk factors for discordant growth hormone and insulin-like growth factor 1 levels following pituitary surgery in acromegaly.
BACKGROUND
Growth hormone (GH)-secreting pituitary adenoma is a chronic disease characterized by excess levels of GH and insulin-like growth factor 1 (IGF-1). Based on our clinical experience and observations, we identified discordant GH and IGF-1 levels after surgery. The risk factors for this phenomenon are unclear, and individualized cure, control criteria, and management after surgery should be considered.


OBJECTIVE
This study aims to investigate the factors affecting the discordant GH and IGF-1 levels after pituitary surgery in acromegalic patients.


METHODS
We retrospectively analyzed 146 patients diagnosed with acromegaly caused by GH-secreting pituitary adenoma who had undergone trans-sphenoidal adenectomy (TSA) at Peking Union Medical College Hospital in 2013. Medical histories were obtained for all patients. Hormone levels, biochemical measurements of liver and renal function, and tumor size were recorded before and 3 months after surgery.


RESULTS
Among the GH-cured patients who had normal GH levels after TSA, 39.2% (20 of 51) had elevated IGF-1. Acromegalic patients with elevated IGF-1 and normal GH levels after TSA had a significantly higher mean body mass index and percentage of upper limit of normal range IGF-1 than the cured patients (p < 0.05). A body mass index greater than >25.0 kg/m2and a percentage of upper limit of normal range IGF-1 higher than 141.5 before TSA might predict the occurrence of hormone-level discordance after surgery.


CONCLUSIONS
Body mass index and percentage of upper limit of normal range IGF-1 before TSA might constitute prognostic risk factors for discordance in IGF-1 and GH levels in acromegaly. Additional attention should be devoted to potential risk factors for this phenomenon, and methods for modifying the cure and control criteria for acromegaly should be developed.
Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; China Pituitary Disease Registry Center, Chinese Pituitary Adenoma Cooperative Group, Beijing, China.
Shuo
S
Zhang
Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; China Pituitary Disease Registry Center, Chinese Pituitary Adenoma Cooperative Group, Beijing, China.
Yilin
Y
Li
Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; China Pituitary Disease Registry Center, Chinese Pituitary Adenoma Cooperative Group, Beijing, China.
Xiaopeng
X
Guo
Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; China Pituitary Disease Registry Center, Chinese Pituitary Adenoma Cooperative Group, Beijing, China.
Lu
L
Gao
Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; China Pituitary Disease Registry Center, Chinese Pituitary Adenoma Cooperative Group, Beijing, China.
Wei
W
Lian
Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; China Pituitary Disease Registry Center, Chinese Pituitary Adenoma Cooperative Group, Beijing, China.
Yong
Y
Yao
Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; China Pituitary Disease Registry Center, Chinese Pituitary Adenoma Cooperative Group, Beijing, China.
Ming
M
Feng
Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; China Pituitary Disease Registry Center, Chinese Pituitary Adenoma Cooperative Group, Beijing, China.
Xinjie
X
Bao
Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; China Pituitary Disease Registry Center, Chinese Pituitary Adenoma Cooperative Group, Beijing, China.
Renzhi
R
Wang
Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; China Pituitary Disease Registry Center, Chinese Pituitary Adenoma Cooperative Group, Beijing, China. Electronic address: xingbingemail@aliyun.com.
Bing
B
Xing
D000172:Acromegaly / Q000097:blood* / Q000601:surgery*; D000328:Adult; D000068476:Beijing; D015992:Body Mass Index; D005260:Female; D049912:Growth Hormone-Secreting Pituitary Adenoma / Q000601:surgery; D019382:Human Growth Hormone / Q000097:blood*; D006801:Humans; D007334:Insulin-Like Growth Factor I / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D010902:Pituitary Gland / Q000601:surgery; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors
D019382:Human Growth Hormone; D007334:Insulin-Like Growth Factor I
acromegaly; growth hormone; insulin-like growth factor 1; pituitary tumor; surgery