Langenbeck's archives of surgery · 2025
Long-term clinical control in acromegaly patients with postoperative discordant nadir growth hormone during oral glucose tolerance test and insulin-like growth factor 1 levels: a retrospective observational study and literature review.
СтатьяНаблюдательное исследованиеОбзорНазвание и аннотация: Перевод пока не подготовлен
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Ishida Tomohisa, Kawaguchi Tomohiro, Ogawa Yoshikazu, Endo Hidenori
Аннотация
BACKGROUND: Postoperative evaluation in patients with acromegaly typically involves measuring insulin-like growth factor 1 (IGF-1) levels and assessing growth hormone (GH) suppression via an oral glucose tolerance test (OGTT). However, discrepancies between these results are not uncommon. Despite this, there are very few studies examining long-term clinical outcomes in patients with persistent discordance between GH nadir and IGF-1 levels. In this study, we focused on such patients and conducted a retrospective analysis to clarify their mid- to long-term outcomes, alongside a review of relevant literature.
METHODS: We retrospectively reviewed patients with acromegaly who underwent transsphenoidal resection of pituitary tumors at a single institution and had serial endocrinological evaluations for more than one year between May 2005 and July 2020. Patients were divided into two groups: those with normal GH suppression during OGTT but elevated IGF-1 levels (Group I) and those with abnormal GH suppression but normal IGF-1 levels (Group II) at their 1-year postoperative evaluation. We investigated whether IGF-1 levels normalized or re-elevated over time, alongside monitoring clinical signs and comorbidity management.
RESULTS: During the study period, 52 patients who were evaluated by serial IGF-1 and OGTT, 10 demonstrated discordance between GH nadir and IGF-1 levels-3 in Group I and 7 in Group II. In all Group I patients, delayed normalization of IGF-1 was observed, taking 3 to 5 years. No IGF-1 re-elevations occurred, and clinical signs and comorbidities were well controlled. In Group II, abnormal GH suppression during OGTT persisted in all patients; however, IGF-1 levels remained within the normal range without re-elevations. Clinical signs and comorbidities remained clinically stable without the need for additional therapy during the 11-year follow-up period.
CONCLUSION: Most patients achieved a mid- to long-term disease-controlled state without additional treatment. Given the potential risk of GH deficiency from further treatment, it may be reasonable to consider patients clinically controlled as long as IGF-1 levels remain normalized, with careful long-term monitoring recommended.
METHODS: We retrospectively reviewed patients with acromegaly who underwent transsphenoidal resection of pituitary tumors at a single institution and had serial endocrinological evaluations for more than one year between May 2005 and July 2020. Patients were divided into two groups: those with normal GH suppression during OGTT but elevated IGF-1 levels (Group I) and those with abnormal GH suppression but normal IGF-1 levels (Group II) at their 1-year postoperative evaluation. We investigated whether IGF-1 levels normalized or re-elevated over time, alongside monitoring clinical signs and comorbidity management.
RESULTS: During the study period, 52 patients who were evaluated by serial IGF-1 and OGTT, 10 demonstrated discordance between GH nadir and IGF-1 levels-3 in Group I and 7 in Group II. In all Group I patients, delayed normalization of IGF-1 was observed, taking 3 to 5 years. No IGF-1 re-elevations occurred, and clinical signs and comorbidities were well controlled. In Group II, abnormal GH suppression during OGTT persisted in all patients; however, IGF-1 levels remained within the normal range without re-elevations. Clinical signs and comorbidities remained clinically stable without the need for additional therapy during the 11-year follow-up period.
CONCLUSION: Most patients achieved a mid- to long-term disease-controlled state without additional treatment. Given the potential risk of GH deficiency from further treatment, it may be reasonable to consider patients clinically controlled as long as IGF-1 levels remain normalized, with careful long-term monitoring recommended.