Debate surrounds the optimal biochemical assessment in the follow-up of patients with
acromegaly, particularly with the introduction of GH receptor antagonists to the treatment algorithm. Consensus statements suggest target values for GH of < 1microgram per litre with normal age and sex matched IGF-1 values. A number of groups have reported on the correlation between IGF-1 and GH levels in small cohorts of acromegalic patients. We retrospectively
analysed IGF-1 and GH data from 349 OGTTs performed on 108 patients (63 females) diagnosed with acromegaly between 1966 and 2001 and with varying degrees of disease activity. Mean age at diagnosis was 45 years (range 16-69). 70 patients had macroadenomas. 24 were treated with primary medical therapy while 84 had been treated with surgery and/or radiotherapy. The
association between simultaneous serum IGF-1 and mean, fasting, nadir and peak GH levels was explored using Spearman correlation analysis. Overall there was a strongly positive correlation between IGF-1 and mean (r=0.66, p<0.0001), fasting (r=0.62, p<0.0001) and nadir (r=0.70, p<0.0001) GH levels. This correlation remained when the confounding effect of repeated measurements on the same patient was eliminated by restricting analysis to the first assessment performed on each patient (mean r=0.67*, fasting r=0.61*, nadir r=0.70*; *p<0.0001). However, only 58% of patients with normal age-matched IGF-1 levels had a nadir GH < 2mU/L, while 87% with elevated IGF-1 levels had a nadir GH > 2mU/L. The correlation
between IGF-1 levels and mean GH levels varied according to treatment modality, ranging from r=0.61 (p<0.0001) with primary medical therapy to r=0.72 (p<0.0001) with surgery. The correlation was stronger in males (r=0.77, p<0.0001) than in females (r=0.58, p<0.0001). We conclude that IGF-1 levels correlate most strongly with nadir GH during an OGTT in patients with acromegaly, but normal IGF-1 levels do not always predict a nadir GH less than 2mU/L.
22 - 24 Mar 2004
British Endocrine Societies