Limits...
Reevaluation of Acromegalic Patients in Long-Term Remission according to Newly Proposed Consensus Criteria for Control of Disease.

Verrua E, Ferrante E, Filopanti M, Malchiodi E, Sala E, Giavoli C, Arosio M, Lania AG, Ronchi CL, Mantovani G, Beck-Peccoz P, Spada A - Int J Endocrinol (2014)

Bottom Line: At the last follow-up visit, in the presence of normal IGF-I concentrations, postglucose GH nadir was over 0.4 μg/L in 11 patients (Group A) and below 0.4 μg/L in 29 patients (Group B); moreover, Group A showed higher basal GH levels than Group B, whereas a significant decline of both GH and postglucose GH nadir levels during the follow-up was observed in Group B only.No differences in other evaluated parameters were found.These results seem to suggest that acromegalic patients considered cured on the basis of previous guidelines do not need a more intensive monitoring than patients who met the current criteria of disease control, supporting instead that the cut-off of 0.4 mcg/L might be too low for the currently used GH assay.

View Article: PubMed Central - PubMed

Affiliation: Endocrinology and Diabetology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Padiglione Granelli, Via F. Sforza 35, 20122 Milan, Italy.

ABSTRACT
Acromegaly guidelines updated in 2010 revisited criteria of disease control: if applied, it is likely that a percentage of patients previously considered as cured might present postglucose GH nadir levels not adequately suppressed, with potential implications on management. This study explored GH secretion, as well as hormonal, clinical, neuroradiological, metabolic, and comorbid profile in a cohort of 40 acromegalic patients considered cured on the basis of the previous guidelines after a mean follow-up period of 17.2 years from remission, in order to assess the impact of the current criteria. At the last follow-up visit, in the presence of normal IGF-I concentrations, postglucose GH nadir was over 0.4 μg/L in 11 patients (Group A) and below 0.4 μg/L in 29 patients (Group B); moreover, Group A showed higher basal GH levels than Group B, whereas a significant decline of both GH and postglucose GH nadir levels during the follow-up was observed in Group B only. No differences in other evaluated parameters were found. These results seem to suggest that acromegalic patients considered cured on the basis of previous guidelines do not need a more intensive monitoring than patients who met the current criteria of disease control, supporting instead that the cut-off of 0.4 mcg/L might be too low for the currently used GH assay.

No MeSH data available.


Related in: MedlinePlus

(a) Mean GH levels in basal condition, evaluated as the mean of at least three consecutive samples, in patients of group A (i.e., GH nadir ≥ 0.4 mcg/L, upper) and group B (i.e., GH nadir < 0.4 mcg/L, lower). Patients of group B showed mean GH levels at long-term follow-up (phase 3) significantly lower than at the time of remission (phase 1), whereas no difference was observed in group A. *P < 0.05 versus phase 1. Values are expressed as mean ± SEM. (b) Mean GH nadir, defined as the lowest GH value at any time after glucose administration (2 h-OGTT), in patients of group A (i.e., GH nadir ≥ 0.4 mcg/L, upper) and group B (i.e., GH nadir < 0.4 mcg/L, lower). Patients of group B showed mean GH nadir levels atlong-term follow-up (phase 3) and at the time of the last assessment available with the GH assay standardized to IS 80/505 (phase 2) significantly lower than at the time of remission (phase 1), whereas the decrease did not reach statistical significance in patients of group A. *P < 0.05 versus phase 1. Values are expressed as mean ± SEM.
© Copyright Policy - open-access
Related In: Results  -  Collection


getmorefigures.php?uid=PMC4283389&req=5

fig1: (a) Mean GH levels in basal condition, evaluated as the mean of at least three consecutive samples, in patients of group A (i.e., GH nadir ≥ 0.4 mcg/L, upper) and group B (i.e., GH nadir < 0.4 mcg/L, lower). Patients of group B showed mean GH levels at long-term follow-up (phase 3) significantly lower than at the time of remission (phase 1), whereas no difference was observed in group A. *P < 0.05 versus phase 1. Values are expressed as mean ± SEM. (b) Mean GH nadir, defined as the lowest GH value at any time after glucose administration (2 h-OGTT), in patients of group A (i.e., GH nadir ≥ 0.4 mcg/L, upper) and group B (i.e., GH nadir < 0.4 mcg/L, lower). Patients of group B showed mean GH nadir levels atlong-term follow-up (phase 3) and at the time of the last assessment available with the GH assay standardized to IS 80/505 (phase 2) significantly lower than at the time of remission (phase 1), whereas the decrease did not reach statistical significance in patients of group A. *P < 0.05 versus phase 1. Values are expressed as mean ± SEM.

Mentions: Considering the current criteria for curing acromegaly, postglucose GH nadir levels over the cut-off limit of 0.4 μg/L were observed in 11 out of the whole cohort of 40 patients (28%) in the presence of normal IGF-I concentrations (group A, 8F&3M, mean age 58.0 ± 7.9 yrs., 3 pts. previously irradiated), whereas the remaining 29 patients had postglucose GH nadir levels below 0.4 μg/L (group B, 17F&12M, mean age 54.3 ± 12.4 yrs., 7 pts. previously irradiated). No statistical difference in IGF-I SDS levels at diagnosis, phases 1 and 2, was found between the two groups (Table 2). Conversely, mean basal GH levels that were evaluated by multiple sampling as suggested by the recent consensus criteria in case of discrepant biochemical results showed a tendency to be higher in group A than in group B, a tendency that reached the statistical significance at the last follow-up (Table 2). During the whole follow-up period, the number of patients of the two groups who showed GH levels greater than safe value of 2.5 μg/L was comparable (Table 2). However, mean GH and postglucose GH nadir levels at last follow-up (phase 3) were significantly lower than phase 1 only in patients of group B (i.e., postglucose GH nadir < 0.4 μg/L, resp., P = 0.03 and P = 0.002), whereas the decrease did not reach statistical significance in patients of group A (Figure 1). The dynamic evaluation of residual GH secretion performed in 22 out of 40 patients (55%), randomly selected in both groups, showed that the number of patients with GH deficiency was not significantly different in group A and group B (data not shown).


Reevaluation of Acromegalic Patients in Long-Term Remission according to Newly Proposed Consensus Criteria for Control of Disease.

Verrua E, Ferrante E, Filopanti M, Malchiodi E, Sala E, Giavoli C, Arosio M, Lania AG, Ronchi CL, Mantovani G, Beck-Peccoz P, Spada A - Int J Endocrinol (2014)

(a) Mean GH levels in basal condition, evaluated as the mean of at least three consecutive samples, in patients of group A (i.e., GH nadir ≥ 0.4 mcg/L, upper) and group B (i.e., GH nadir < 0.4 mcg/L, lower). Patients of group B showed mean GH levels at long-term follow-up (phase 3) significantly lower than at the time of remission (phase 1), whereas no difference was observed in group A. *P < 0.05 versus phase 1. Values are expressed as mean ± SEM. (b) Mean GH nadir, defined as the lowest GH value at any time after glucose administration (2 h-OGTT), in patients of group A (i.e., GH nadir ≥ 0.4 mcg/L, upper) and group B (i.e., GH nadir < 0.4 mcg/L, lower). Patients of group B showed mean GH nadir levels atlong-term follow-up (phase 3) and at the time of the last assessment available with the GH assay standardized to IS 80/505 (phase 2) significantly lower than at the time of remission (phase 1), whereas the decrease did not reach statistical significance in patients of group A. *P < 0.05 versus phase 1. Values are expressed as mean ± SEM.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4283389&req=5

fig1: (a) Mean GH levels in basal condition, evaluated as the mean of at least three consecutive samples, in patients of group A (i.e., GH nadir ≥ 0.4 mcg/L, upper) and group B (i.e., GH nadir < 0.4 mcg/L, lower). Patients of group B showed mean GH levels at long-term follow-up (phase 3) significantly lower than at the time of remission (phase 1), whereas no difference was observed in group A. *P < 0.05 versus phase 1. Values are expressed as mean ± SEM. (b) Mean GH nadir, defined as the lowest GH value at any time after glucose administration (2 h-OGTT), in patients of group A (i.e., GH nadir ≥ 0.4 mcg/L, upper) and group B (i.e., GH nadir < 0.4 mcg/L, lower). Patients of group B showed mean GH nadir levels atlong-term follow-up (phase 3) and at the time of the last assessment available with the GH assay standardized to IS 80/505 (phase 2) significantly lower than at the time of remission (phase 1), whereas the decrease did not reach statistical significance in patients of group A. *P < 0.05 versus phase 1. Values are expressed as mean ± SEM.
Mentions: Considering the current criteria for curing acromegaly, postglucose GH nadir levels over the cut-off limit of 0.4 μg/L were observed in 11 out of the whole cohort of 40 patients (28%) in the presence of normal IGF-I concentrations (group A, 8F&3M, mean age 58.0 ± 7.9 yrs., 3 pts. previously irradiated), whereas the remaining 29 patients had postglucose GH nadir levels below 0.4 μg/L (group B, 17F&12M, mean age 54.3 ± 12.4 yrs., 7 pts. previously irradiated). No statistical difference in IGF-I SDS levels at diagnosis, phases 1 and 2, was found between the two groups (Table 2). Conversely, mean basal GH levels that were evaluated by multiple sampling as suggested by the recent consensus criteria in case of discrepant biochemical results showed a tendency to be higher in group A than in group B, a tendency that reached the statistical significance at the last follow-up (Table 2). During the whole follow-up period, the number of patients of the two groups who showed GH levels greater than safe value of 2.5 μg/L was comparable (Table 2). However, mean GH and postglucose GH nadir levels at last follow-up (phase 3) were significantly lower than phase 1 only in patients of group B (i.e., postglucose GH nadir < 0.4 μg/L, resp., P = 0.03 and P = 0.002), whereas the decrease did not reach statistical significance in patients of group A (Figure 1). The dynamic evaluation of residual GH secretion performed in 22 out of 40 patients (55%), randomly selected in both groups, showed that the number of patients with GH deficiency was not significantly different in group A and group B (data not shown).

Bottom Line: At the last follow-up visit, in the presence of normal IGF-I concentrations, postglucose GH nadir was over 0.4 μg/L in 11 patients (Group A) and below 0.4 μg/L in 29 patients (Group B); moreover, Group A showed higher basal GH levels than Group B, whereas a significant decline of both GH and postglucose GH nadir levels during the follow-up was observed in Group B only.No differences in other evaluated parameters were found.These results seem to suggest that acromegalic patients considered cured on the basis of previous guidelines do not need a more intensive monitoring than patients who met the current criteria of disease control, supporting instead that the cut-off of 0.4 mcg/L might be too low for the currently used GH assay.

View Article: PubMed Central - PubMed

Affiliation: Endocrinology and Diabetology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Padiglione Granelli, Via F. Sforza 35, 20122 Milan, Italy.

ABSTRACT
Acromegaly guidelines updated in 2010 revisited criteria of disease control: if applied, it is likely that a percentage of patients previously considered as cured might present postglucose GH nadir levels not adequately suppressed, with potential implications on management. This study explored GH secretion, as well as hormonal, clinical, neuroradiological, metabolic, and comorbid profile in a cohort of 40 acromegalic patients considered cured on the basis of the previous guidelines after a mean follow-up period of 17.2 years from remission, in order to assess the impact of the current criteria. At the last follow-up visit, in the presence of normal IGF-I concentrations, postglucose GH nadir was over 0.4 μg/L in 11 patients (Group A) and below 0.4 μg/L in 29 patients (Group B); moreover, Group A showed higher basal GH levels than Group B, whereas a significant decline of both GH and postglucose GH nadir levels during the follow-up was observed in Group B only. No differences in other evaluated parameters were found. These results seem to suggest that acromegalic patients considered cured on the basis of previous guidelines do not need a more intensive monitoring than patients who met the current criteria of disease control, supporting instead that the cut-off of 0.4 mcg/L might be too low for the currently used GH assay.

No MeSH data available.


Related in: MedlinePlus