| Early postoperative growth hormone levels: high predictive value for long-term outcome after surgery for acromegaly. | |
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MedLine Citation:
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PMID: 10886485 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVES: To explore the prognostic value of early - within 1 week - postoperative growth hormone (GH) measurements with regard to outcome after surgery for acromegaly in a short- and a long-term perspective. DESIGN: Retrospective study of patients operated on between 1987 and 1998, including follow-up for up to 60 months. SETTING: University hospital. SUBJECTS: Sixty-eight patients with acromegaly. INTERVENTION: Pituitary surgery aiming at adenomectomy with preservation of pituitary function. MAIN OUTCOME MEASURES: The effect of the operation was evaluated after 3 months, mostly by means of an oral glucose load or by insulin-like growth factor 1 (IGF-1). The specificity, sensitivity and the predictive values of an early postoperative mean GH concentration </= 4.8 mU L-1, as well as of the GH response to thyrotropin-releasing hormone (TRH) 3 months after surgery, were calculated with regard to outcome of the operation in both 3-month and long-term perspectives. RESULTS: Fifty patients (73.5%) showed a satisfactory effect at the evaluation 3 months postoperatively; 45 of these were followed between 12 and 60 months. Relapse was registered in five cases: 12, 12, 24, 24 and 48 months after surgery. In the long-term perspective, the predictive value of an early mean GH </= 4.8 mU L-1 was 93.6% with regard to a satisfactory effect of surgery, compared with 90.2% for a normalized somatomedin C (SmC)/IGF-1 and 90.0% for an absent GH response after TRH. An early mean GH > 4.8 mU L-1 had a 77.8% predictive value for persistent or recurrent disease, compared with 85.7% for persistently increased SmC/IGF-1 and 68.8% for an abnormal GH release after TRH 3 months after surgery. In the short-term perspective, the specificity and the predictive value of an early GH </= 4.8 mU L-1 were 77.3 and 97.1%, respectively. Early GH > 4.8 mU L-1 had a 94.4% sensitivity but a predicative value of only 63.0% for an unsatisfactory effect. CONCLUSION: Measurement of GH within 1 week after surgery is highly predictive for outcome of surgery for acromegaly. Specifically, an early mean GH </= 4.8 mU L-1 is as predictive for a satisfactory effect of treatment as a normalized IGF-1 3 months after surgery. Early postoperative GH values > 4.8 mU L-1 have a high sensitivity for persistent or recurrent disease in both the short- and long-term perspectives, but lower predictive value. The usefulness of the TRH test can be questioned. |
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Authors:
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S Valdemarsson; S Ljunggren; M Bramnert; O Norrhamn; C H Nordström |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Journal of internal medicine Volume: 247 ISSN: 0954-6820 ISO Abbreviation: J. Intern. Med. Publication Date: 2000 Jun |
Date Detail:
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Created Date: 2000-07-25 Completed Date: 2000-07-25 Revised Date: 2004-11-17 |
Medline Journal Info:
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Nlm Unique ID: 8904841 Medline TA: J Intern Med Country: ENGLAND |
Other Details:
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Languages: eng Pagination: 640-50 Citation Subset: IM |
Affiliation:
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Department of Internal Medicine, Lund University Hospital, Malmö, Sweden. stig.valdemarsson@skane.se |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Acromegaly
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blood*,
surgery* Adult Aged Aged, 80 and over Female Follow-Up Studies Human Growth Hormone / blood* Humans Insulin-Like Growth Factor I / metabolism Male Middle Aged Postoperative Period Predictive Value of Tests Recurrence Retrospective Studies Sensitivity and Specificity Time Factors |
| Chemical | |
Reg. No./Substance:
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12629-01-5/Human Growth Hormone; 67763-96-6/Insulin-Like Growth Factor I |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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