Document Detail


Early postoperative indicators of late outcome in acromegalic patients.
MedLine Citation:
PMID:  15009003     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: According to current criteria, normalised serum IGF-1 and glucose-suppressed GH < 1 ng/ml are indicators of biochemical cure in acromegalic patients. We performed a retrospective study to assess whether the attainment of these values in the early postoperative period was predictive of future IGF-1 normalisation and disease inactivity.
PATIENTS, MEASUREMENTS AND RESULTS: Between 1978 and 1999, 78 acromegalic patients underwent resection for pituitary adenomas. At the end of the mean follow-up period of 7 years, 43 (55.1%) showed normalised IGF-1 levels and no disease activity. In 51 cases, both IGF-1 and glucose-suppressed GH were examined within the first postoperative month. Of this group, all 19 patients who had early glucose-suppressed GH < 1 ng/ml and were treated by surgery alone maintained normal IGF-1 levels throughout the follow-up; four of them demonstrated delayed (i.e. more than 30 days after the operation) IGF-1 normalisation. In 19 patients with early glucose-suppressed GH levels of 1-4 ng/ml, seven of 11 patients with early normalised IGF-1 and two of eight patients with early IGF-1 elevation manifested eventual IGF-1 normalisation. However, none of the 13 patients with early glucose-suppressed GH > 4 ng/ml attained IGF-1 normalisation. Both univariate and multivariate analyses indicated that early glucose-suppressed GH was a significant factor for predicting late normalised IGF-1; the cut-off value was 1.5 ng/ml (sensitivity: 0.97; specificity: 0.75; odds ratio: 90).
CONCLUSION: The attainment of both normalised IGF-1 and glucose-suppressed GH < 1 ng/ml, even during the early postoperative period, suggests absolute cure in acromegalic patients. However, even in patients who do not meet both criteria within the first postoperative month, glucose-suppressed GH < 1.5 ng/ml, or glucose-suppressed GH < 4 ng/ml coupled with early IGF-1 normalisation indicate the possibility of eventual normalisation of IGF-1 and disease inactivity without adjuvant therapy. These postoperative parameters may be useful for assessing the desirability of further treatment.
Authors:
Jun A Takahashi; Akira Shimatsu; Kazuwa Nakao; Nobuo Hashimoto
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Clinical endocrinology     Volume:  60     ISSN:  0300-0664     ISO Abbreviation:  Clin. Endocrinol. (Oxf)     Publication Date:  2004 Mar 
Date Detail:
Created Date:  2004-03-10     Completed Date:  2004-05-20     Revised Date:  2013-07-15    
Medline Journal Info:
Nlm Unique ID:  0346653     Medline TA:  Clin Endocrinol (Oxf)     Country:  England    
Other Details:
Languages:  eng     Pagination:  366-74     Citation Subset:  IM    
Affiliation:
Department of Neurosurgery, Kyoto University Graduate School of Medicine, Japan. jat@kuhp.kyoto-u.ac.jp
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MeSH Terms
Descriptor/Qualifier:
Acromegaly / etiology,  surgery*
Adenoma / blood,  complications,  surgery
Adolescent
Adult
Aged
Depression, Chemical
Female
Follow-Up Studies
Glucose / diagnostic use
Growth Hormone / blood*
Humans
Insulin-Like Growth Factor I / analysis*
Logistic Models
Male
Middle Aged
Pituitary Neoplasms / blood,  complications,  surgery
Postoperative Period
Retrospective Studies
Treatment Outcome
Chemical
Reg. No./Substance:
50-99-7/Glucose; 67763-96-6/Insulin-Like Growth Factor I; 9002-72-6/Growth Hormone

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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