Searchable abstracts of presentations at key conferences in endocrinology
Endocrine Abstracts (2015) 38 P314 | DOI: 10.1530/endoabs.38.P314

SFEBES2015 Poster Presentations Pituitary (48 abstracts)

Biochemical assessment of disease activity in acromegaly; a comparison of single GH, GH day series mean, OGTT nadir and IGF-1 in 51 patients

Kirupakaran Arun 1 , Andrew S Powlson 1 , Afzal N Chaudhry 2 , David J Halsall 3 & Mark Gurnell 1

1Metabolic Research Laboratories, Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, UK; 2Department of Medicine, University of Cambridge, Cambridge, UK; 3Department of Clinical Biochemistry, Addenbrooke’s Hospital, Cambridge, UK.

Background: Accurate assessment of GH & IGF1 status in acromegaly is crucial for informing management to minimise excess morbidity/mortality. Expert panels have differed with respect to recommended testing modalities and thresholds – the most recent being the Endocrine Society 2014 guidelines. We evaluated their simplified algorithm, which minimises the need for day-case testing, against other more resource-intensive measures.

Methods: A retrospective analysis was performed of prospectively collected data from a cohort of 51 patients with acromegaly, who received up to 6 months of pre-surgical medical therapy prior to transsphenoidal surgery. Single 0900 h GH and IGF1 levels were recorded at diagnosis, post-medical therapy and post-surgery. OGTT nadir was determined at diagnosis and post-operatively. GH day curve mean (GHDC) was measured at diagnosis and after medical treatment.

Results: A single 0900 h GH value correlated well with GHDC results both at diagnosis (R2=0.94, P<0.0001) and following medical treatment (R2=0.92, P<0.0001). Three patients were below the suggested target of 1 μg/l on a single GH reading post-medical therapy, but had a GHDC >1 μg/l; all three had an IGF1 above the upper limit of normal (ULN). Four patients had a 0900 h GH >1 μg/l, but a GHDC <1 μg/l and an IGF <ULN. Post-operatively, a single 0900 h GH reading of <1*** μg/L was observed in 3 patients who failed to suppress to <0.4 μg/l on an OGTT, although suppression in each case was to <1 μg/l; two of these had an IGF1 >ULN. Five patients with a 0900 h GH >1 μg/l suppressed to <0.4 μg/l on OGTT; IGF1 was <ULN in one of these.

Conclusions: In the majority of patients, a single measurement of GH status together with IGF1 provides an accurate assessment of biochemical control in acromegaly. For the small number of cases in whom 090 h GH and IGF1 are discordant, GHDC (post-medical therapy) and OGTT nadir (post-surgery) remain important adjuncts.

Volume 38

Society for Endocrinology BES 2015

Edinburgh, UK
02 Nov 2015 - 04 Nov 2015

Society for Endocrinology 

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