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The ongoing challenge of discrepant growth hormone and insulin‐like growth factor I results in the evaluation of treated acromegalic patients: a systematic review and meta‐analysis
Author(s) -
Kanakis G.A.,
Chrisoulidou A.,
Bargiota A.,
Efstathiadou Z.A.,
Papanastasiou L.,
Theodoropoulou A.,
Tigas S.K.,
Vassiliadi D.A.,
Tsagarakis S.,
Alevizaki M.
Publication year - 2016
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 - 10.1111/cen.13129
Subject(s) - meta analysis , growth hormone , insulin like growth factor , acromegaly , medicine , endocrinology , growth factor , somatomedin , insulin , hormone , receptor
Summary Objective Growth hormone ( GH ) and insulin‐like growth factor I ( IGF ‐ I ) are the principal biomarkers used to assess disease activity in acromegaly, and any discrepancy between them renders interpretation of results inconclusive. Purpose of this study was to assess the frequency of this discrepancy and identify parameters that might affect its occurrence. Design A systematic review of MEDLINE and S copus was performed (1987–2013) followed by a meta‐analysis to address the frequency of discrepant results between GH and IGF ‐ I levels. Meta‐regression and subgroup analyses were performed assessing the effects of the year of publication, the different types of GH testing and GH assays used, as well as the impact of treatment with somatostatin analogues ( SSA s) on the occurrence of this discrepancy. Results The analysis retrieved 39 eligible studies totalling 7071 patients. The pooled discordance rate between GH and IGF ‐ I was 25·7% (95% CI : 22·3–29·4), and the predominant format was that of elevated IGF ‐ I with normal GH levels (15·3%, 95% CI : 12·5–18·7). No significant correlation between the discordance rate and the year of publication was shown; whereas, the use of ultrasensitive GH assays resulted in higher discordance rates (30·7%, 95% CI : 25·9–35·9 vs 19·8%, 95% CI : 14·1–27·2, P = 0·04) as did treatment with SSA s (32·5%, 95% CI : 27·8–37·4) vs (21·6%, 95% CI : 17·8–25·6, P = 0·001). Conclusions Discrepancy between GH and IGF ‐ I results is encountered in a quarter of treated patients with acromegaly, especially when using ultrasensitive GH assays or in patients receiving SSA s, a fact that the clinician should take into consideration when making clinical decisions.