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Serum IGF-1 in the diagnosis of acromegaly and the profile of patients with elevated IGF-1 but normal glucose-suppressed growth hormone.
MedLine Citation:
PMID:  22784832     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Objective: To report the utility of IGF-1 as a single biomarker for establishing the diagnosis of acromegaly and to examine the clinical and biochemical profile of patients with an elevated IGF-1 in whom a diagnosis of acromegaly could not be confirmed by means of the oral glucose tolerance test (OGTT).Methods: Between the years 1999 and 2010, we identified 101 patients who underwent pituitary surgery and had histologically proven somatotroph adenomas (Group 1, Gr 1). We selected 149 patients with non-GH secreting pituitary macroadenomas (Gr 2, n=97) and microadenomas (Gr 3, n=52) to serve as controls. In addition, we identified 34 patients with elevated IGF-1values in whom acromegaly could not subsequently be proven by the OGTT (Gr 4).Results: IGF-1 was elevated in all patients with acromegaly prior to therapy with a median (range) standard deviation score (SDS) of +9.52 (+2.34 to +39.2), compared to SDS -1.46 (-2.91 to +2.17) and -1.22 (-2.8 to +1.58) in Gr 2 and 3, respectively (P< 0.001). IGF-1 SDS values were +3.28 (+2.05 to +6.12), and IGF-1 was less than twice the upper limit of normal in all patients in Gr 4. OGTT was performed in 51 of the 101 acromegalic patients. The nadir GH in these patients was 4.01 (0.2 -46.7) compared to 0.2 (<0.05- 0.6) in Gr 4 (P<0.001).Conclusion: Elevated IGF-1 levels, alone, are sufficient to establish a diagnosis of acromegaly in the majority of clinically suspected cases. The OGTT may be useful to obtain corroborative evidence when there is modest elevation of IGF-1 with absent or equivocal clinical features.
Authors:
Sreevidya Subbarayan; Maria Fleseriu; Murray Gordon; Jessica Brzana; Laurence Kennedy; Charles Faiman; Betul Hatipoglu; Richard A Prayson; Johnny B Delashaw; Robert J Weil; Amir H Hamrahian
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-7-11
Journal Detail:
Title:  Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists     Volume:  -     ISSN:  1934-2403     ISO Abbreviation:  -     Publication Date:  2012 Jul 
Date Detail:
Created Date:  2012-7-12     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9607439     Medline TA:  Endocr Pract     Country:  -    
Other Details:
Languages:  ENG     Pagination:  1-24     Citation Subset:  -    
Affiliation:
Department of Endocrinology, Diabetes and Metabolism, Cleveland Clinic, Cleveland, OH.
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