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Early postoperative indicators of late outcome in acromegalic patients
Author(s) -
Takahashi Jun A.,
Shimatsu Akira,
Nakao Kazuwa,
Hashimoto Nobuo
Publication year - 2004
Publication title -
clinical endocrinology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.055
H-Index - 147
eISSN - 1365-2265
pISSN - 0300-0664
DOI - 10.1046/j.1365-2265.2003.01900.x
Subject(s) - medicine , acromegaly , endocrinology , odds ratio , univariate analysis , multivariate analysis , gastroenterology , growth hormone , hormone
Summary objective According to current criteria, normalised serum IGF‐1 and glucose‐suppressed GH < 1 ng/ml are indicators of biochemical cure in acromegalic patients. We performed a retrospective study to assess whether the attainment of these values in the early postoperative period was predictive of future IGF‐1 normalisation and disease inactivity. patients, measurements and results Between 1978 and 1999, 78 acromegalic patients underwent resection for pituitary adenomas. At the end of the mean follow‐up period of 7 years, 43 (55·1%) showed normalised IGF‐1 levels and no disease activity. In 51 cases, both IGF‐1 and glucose‐suppressed GH were examined within the first postoperative month. Of this group, all 19 patients who had early glucose‐suppressed GH < 1 ng/ml and were treated by surgery alone maintained normal IGF‐1 levels throughout the follow‐up; four of them demonstrated delayed (i.e. more than 30 days after the operation) IGF‐1 normalisation. In 19 patients with early glucose‐suppressed GH levels of 1–4 ng/ml, seven of 11 patients with early normalised IGF‐1 and two of eight patients with early IGF‐1 elevation manifested eventual IGF‐1 normalisation. However, none of the 13 patients with early glucose‐suppressed GH > 4 ng/ml attained IGF‐1 normalisation. Both univariate and multivariate analyses indicated that early glucose‐suppressed GH was a significant factor for predicting late normalised IGF‐1; the cut‐off value was 1·5 ng/ml (sensitivity: 0·97; specificity: 0·75; odds ratio: 90). conclusion The attainment of both normalised IGF‐1 and glucose‐suppressed GH < 1 ng/ml, even during the early postoperative period, suggests absolute cure in acromegalic patients. However, even in patients who do not meet both criteria within the first postoperative month, glucose‐suppressed GH < 1·5 ng/ml, or glucose‐suppressed GH < 4 ng/ml coupled with early IGF‐1 normalisation indicate the possibility of eventual normalisation of IGF‐1 and disease inactivity without adjuvant therapy. These postoperative parameters may be useful for assessing the desirability of further treatment.