Postoperative evaluation of patients with acromegaly: Clinical significance and timing of oral glucose tolerance testing and measurement of (free) insulin-like growth factor I, acid-labile subunit, and growth hormone-binding protein levels
Postoperative evaluation of patients with acromegaly: Clinical significance and timing of oral glucose tolerance testing and measurement of (free) insulin-like growth factor I, acid-labile subunit, and growth hormone-binding protein levels
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DOI：
10.1210/jc.2005-0901
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发表时间：
2005-12-01
影响因子：
5.8
通讯作者：
de Herder, WW
中科院分区：
文献类型：
--
作者：
Feelders, RA;Bidlingmaier, M;de Herder, WW
内容：目前尚不清楚肢端肥大症患者在经蝶窦腺瘤切除术（TA）后何时应进行治愈评估。目的：本研究的目的是通过连续测量葡萄糖抑制的GH水平[口服葡萄糖耐量试验（OGTT）]和GH依赖性参数IGF-I、游离IGF-I、酸不稳定亚基（ALS），设计：我们描述了一项前瞻性研究，随访1年。设置：这项研究是在一所大学医院进行的。患者：17例肢端肥大症患者被纳入本研究。主要结果指标：主要结果指标是TA后1，2，3，8和12周的OGTT结果;每周测量生长激素，（游离）IGF-I，ALS，GHBP水平高达12周;和总IGF-I水平测量在52 wk.Results：术后，9例患者缓解OGTT生长激素最低点小于0.5微克/升和正常的IGF-I水平，而8例患者有持续性肢端肥大症。在治愈和未治愈的患者中，TA后1周的OGTT结果随着时间的推移具有高度可重复性。相反，术后早期IGF-I水平波动，仅在12周稳定。在所有治愈的患者中，游离IGF-I水平在TA后2周内迅速恢复正常（特异性，100%）。所有患者术前ALS水平均升高，仅在TA后治愈的患者中恢复正常（特异性，89%）。术前GHBP水平较低，增加2 wk after surgery.Conclusions：我们表明，在肢端肥大症患者的术后评价，已经1周手术后，OGTT使用0.5微克作为GH最低点截止值有很高的预测值治愈，而早期IGF-I水平显示不同的模式走向稳定。因此，IGF-I不应在术后3个月内测量作为预测参数。游离IGF-I和ALS水平在术后评估疾病活动性中可能具有额外的价值。
Context: It is not exactly known when patients with acromegaly should be evaluated for cure after transsphenoidal adenomectomy (TA).Objective: The objective of this study was to define the optimal time point of postoperative evaluation by serial measurements of glucose-suppressed GH levels [oral glucose tolerance test (OGTT)] and the GH-dependent parameters IGF-I, free IGF-I, acid labile subunit (ALS), and GH-binding protein (GHBP).Design: We describe a prospective study with 1-yr follow-up.Setting: The study was conducted at a university hospital.Patients: Seventeen patients with acromegaly were included in the study.Main Outcome Measures: The main outcome measures were OGTT results at 1, 2, 3, 8, and 12 wk after TA; weekly measured GH, (free) IGF-I, ALS, and GHBP levels up to 12 wk; and total IGF-I levels measured at 52 wk.Results: Postoperatively, nine patients were in remission with an OGTT GH nadir of less than 0.5 mu g/liter and normalized IGF-I levels, whereas eight patients had persistent acromegaly. In both cured and noncured patients, OGTT results at 1 wk after TA were highly reproducible over time. In contrast, early postoperative IGF-I levels fluctuated and only stabilized at 12 wk. In all cured patients, free IGF-I levels rapidly normalized within 2 wk after TA (specificity, 100%). Preoperative ALS levels were elevated in all patients and normalized only in the cured patients after TA (specificity, 89%). Preoperative GHBP levels were low and increased from 2 wk after surgery.Conclusions: We show that in the postoperative evaluation of patients with acromegaly, already 1 wk after surgery, an OGTT using 0.5 mu g as the GH nadir cutoff value has a high predictive value for cure, whereas early IGF-I levels show varying patterns toward stabilization. Therefore, IGF-I should be measured as a predictive parameter not within 3 months after surgery. Free IGF-I and ALS levels may have an additional value in the postoperative assessment of disease activity.