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Predicting long term remission by measuring immediate postoperative growth hormone levels and oral glucose tolerance test in acromegaly.
MedLine Citation:
PMID:  22067418     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND: The suppression of the growth hormone (GH) in an oral glucose tolerance test (OGTT) has been accepted as the most reliable parameter for determining remission of acromegaly. OBJECTIVE: To evaluate the role of immediate postoperative GH level and 1-wk postoperative OGTT as early predictive tools of long-term surgical remission. METHODS: One hundred ninety-four acromegalic patients who received transsphenoidal tumor resection and were followed up for longer than 1.5 yr (3.80 ± .17 yr), with at least three postoperative OGTTs, were evaluated. GH was measured 2, 6, 12, 18, 24, 48, and 72 h postoperatively and an OGTT was performed 1 wk after surgery, every 6 months for the first 3 yr and annually thereafter. RESULTS: One hundred seventy-seven patients underwent gross total resection, and long-term remission was achieved in 153. The GH level at 24 h after surgery showed the highest predictive power for long-term remission. Long-term remission was maintained in 125/127 (98.4%) patients who had nadir GH levels < 1.0 μg/liter in an early postoperative OGTT. However, when nadir GH levels were higher than 1.0 μg/liter in an early postoperative OGTT, long-term remission was observed in 28 patients (28/67, 41.8%) in a delayed fashion. One-week postoperative OGTT had a sensitivity of 81.7% and specificity of 95.1% for predicting remission. CONCLUSION: Immediate postoperative GH level is a very good predictor of long-term outcome in acromegaly. One-week postoperative OGTT is also a good predictor with high specificity. These findings may provide critical information for the determination of adjuvant treatment after surgery.
Authors:
Eui Hyun Kim; Min Chul Oh; Eun Jig Lee; Sun Ho Kim
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-11-3
Journal Detail:
Title:  Neurosurgery     Volume:  -     ISSN:  1524-4040     ISO Abbreviation:  -     Publication Date:  2011 Nov 
Date Detail:
Created Date:  2011-11-9     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7802914     Medline TA:  Neurosurgery     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
1Neurosurgery, Yonsei Brain Research Institute 2Pituitary Tumor Clinic, Institute of Endocrinology 3Endocrinology, and, Brain Korea 21 Project for Medical Science, Severance Hospital Integrative Research Institute for Cerebral & Cardiovascular Diseases, Yonsei University College of Medicine, Seoul, Korea 4Endocrinology, Northwestern University Feinberg School of Medicine, Chicago, IL.
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