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Clinical and hormonal findings in patients presenting with high IGF-1 and growth hormone suppression after oral glucose load: a retrospective cohort study

OBJECTIVE: High insulin-like growth factor 1 (IGF-1) and unsuppressed growth hormone (GH) levels after glucose load confirm the diagnosis of acromegaly. Management of patients with conflicting results could be challenging. Our aim was to evaluate the clinical and hormonal evolution over a long follo...

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Autores principales: Carosi, Giulia, Mangone, Alessandra, Sala, Elisa, Del Sindaco, Giulia, Mungari, Roberta, Cremaschi, Arianna, Ferrante, Emanuele, Arosio, Maura, Mantovani, Giovanna
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Bioscientifica Ltd 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8284905/
https://www.ncbi.nlm.nih.gov/pubmed/34081617
http://dx.doi.org/10.1530/EJE-21-0024
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author Carosi, Giulia
Mangone, Alessandra
Sala, Elisa
Del Sindaco, Giulia
Mungari, Roberta
Cremaschi, Arianna
Ferrante, Emanuele
Arosio, Maura
Mantovani, Giovanna
author_facet Carosi, Giulia
Mangone, Alessandra
Sala, Elisa
Del Sindaco, Giulia
Mungari, Roberta
Cremaschi, Arianna
Ferrante, Emanuele
Arosio, Maura
Mantovani, Giovanna
author_sort Carosi, Giulia
collection PubMed
description OBJECTIVE: High insulin-like growth factor 1 (IGF-1) and unsuppressed growth hormone (GH) levels after glucose load confirm the diagnosis of acromegaly. Management of patients with conflicting results could be challenging. Our aim was to evaluate the clinical and hormonal evolution over a long follow-up in patients with high IGF-1 but normal GH nadir (GHn < 0.4 μg/L according to the latest guidelines). DESIGN: Retrospective cohort study. METHODS: We enrolled 53 patients presenting high IGF-1 and GHn < 0.4 μg/L, assessed because of clinical suspicion of acromegaly or in other endocrinological contexts (e.g. pituitary incidentaloma). Clinical and hormonal data collected at the first and last visit were analyzed. RESULTS: At the first evaluation, the mean age was 54.1 ± 15.4 years, 34/53 were females, median IGF-1 and GHn were +3.1 SDS and 0.06 μg/L, respectively. In the whole group, over a median time of 6 years, IGF-1 and GHn levels did not significantly change (IGF-1 mean of differences: −0.58, P = 0.15; GHn +0.03, P = 0.29). In patients with clinical features of acromegaly, the prevalence of acromegalic comorbidities was higher than in the others (median of 3 vs 1 comorbidities per patient, P = 0.005), especially malignancies (36% vs 6%, P = 0.03), and the clinical worsening overtime was more pronounced (4 vs 1 comorbidities at the last visit). CONCLUSIONS: In patients presenting high IGF-1 but GHn < 0.4 μg/L, a hormonal progression is improbable, likely excluding classical acromegaly in its early stage. However, despite persistently low GH nadir values, patients with acromegalic features present more acromegalic comorbidities whose rate increases over time. Close clinical surveillance of this group is advised.
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spelling pubmed-82849052021-07-20 Clinical and hormonal findings in patients presenting with high IGF-1 and growth hormone suppression after oral glucose load: a retrospective cohort study Carosi, Giulia Mangone, Alessandra Sala, Elisa Del Sindaco, Giulia Mungari, Roberta Cremaschi, Arianna Ferrante, Emanuele Arosio, Maura Mantovani, Giovanna Eur J Endocrinol Clinical Study OBJECTIVE: High insulin-like growth factor 1 (IGF-1) and unsuppressed growth hormone (GH) levels after glucose load confirm the diagnosis of acromegaly. Management of patients with conflicting results could be challenging. Our aim was to evaluate the clinical and hormonal evolution over a long follow-up in patients with high IGF-1 but normal GH nadir (GHn < 0.4 μg/L according to the latest guidelines). DESIGN: Retrospective cohort study. METHODS: We enrolled 53 patients presenting high IGF-1 and GHn < 0.4 μg/L, assessed because of clinical suspicion of acromegaly or in other endocrinological contexts (e.g. pituitary incidentaloma). Clinical and hormonal data collected at the first and last visit were analyzed. RESULTS: At the first evaluation, the mean age was 54.1 ± 15.4 years, 34/53 were females, median IGF-1 and GHn were +3.1 SDS and 0.06 μg/L, respectively. In the whole group, over a median time of 6 years, IGF-1 and GHn levels did not significantly change (IGF-1 mean of differences: −0.58, P = 0.15; GHn +0.03, P = 0.29). In patients with clinical features of acromegaly, the prevalence of acromegalic comorbidities was higher than in the others (median of 3 vs 1 comorbidities per patient, P = 0.005), especially malignancies (36% vs 6%, P = 0.03), and the clinical worsening overtime was more pronounced (4 vs 1 comorbidities at the last visit). CONCLUSIONS: In patients presenting high IGF-1 but GHn < 0.4 μg/L, a hormonal progression is improbable, likely excluding classical acromegaly in its early stage. However, despite persistently low GH nadir values, patients with acromegalic features present more acromegalic comorbidities whose rate increases over time. Close clinical surveillance of this group is advised. Bioscientifica Ltd 2021-06-03 /pmc/articles/PMC8284905/ /pubmed/34081617 http://dx.doi.org/10.1530/EJE-21-0024 Text en © The authors https://creativecommons.org/licenses/by/4.0/ This work is licensed under a Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Clinical Study
Carosi, Giulia
Mangone, Alessandra
Sala, Elisa
Del Sindaco, Giulia
Mungari, Roberta
Cremaschi, Arianna
Ferrante, Emanuele
Arosio, Maura
Mantovani, Giovanna
Clinical and hormonal findings in patients presenting with high IGF-1 and growth hormone suppression after oral glucose load: a retrospective cohort study
title Clinical and hormonal findings in patients presenting with high IGF-1 and growth hormone suppression after oral glucose load: a retrospective cohort study
title_full Clinical and hormonal findings in patients presenting with high IGF-1 and growth hormone suppression after oral glucose load: a retrospective cohort study
title_fullStr Clinical and hormonal findings in patients presenting with high IGF-1 and growth hormone suppression after oral glucose load: a retrospective cohort study
title_full_unstemmed Clinical and hormonal findings in patients presenting with high IGF-1 and growth hormone suppression after oral glucose load: a retrospective cohort study
title_short Clinical and hormonal findings in patients presenting with high IGF-1 and growth hormone suppression after oral glucose load: a retrospective cohort study
title_sort clinical and hormonal findings in patients presenting with high igf-1 and growth hormone suppression after oral glucose load: a retrospective cohort study
topic Clinical Study
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8284905/
https://www.ncbi.nlm.nih.gov/pubmed/34081617
http://dx.doi.org/10.1530/EJE-21-0024
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