Revisiting the Role of Insulin-like Growth Factor-1 Measurement After Surgical Treatment of Acromegaly.

Abstract

CONTEXT:

In the management of growth hormone (GH)-secreting pituitary adenomas, the oral glucose tolerance test (OGTT) has been the gold standard not only for diagnoses but also for the determination of biochemical remission. Insulin-like growth factor-1 (IGF-1) is an essential biomarker, although it should be adjusted for both age and sex.

OBJECTIVE:

We evaluated whether IGF-1 levels could serve as a reliable alternative to an OGTT for disease monitoring after the surgical treatment of acromegaly. We retrospectively reviewed the medical records of 320 patients who underwent surgical resection of their GH-secreting pituitary tumors at the Severance hospital. Receiver operator characteristic (ROC) analyses were performed to validate the accuracy of IGF-1 levels for the assessment of remission. In addition, regression analyses were performed to identify factors associated with discrepancy between OGTT and IGF-1 levels.

RESULTS:

Except for 1 week after surgery, ROC analyses showed an area under the curve of greater than 0.8 for IGF-1 at all time points. Of 320 patients, 270 achieved endocrine remission after surgery alone. Among these patients, IGF-1 levels were normalized in 250 patients. The mean duration from surgery to IGF-1 normalization was 4.7 months. Regression analyses demonstrated that risk of failed IGF-1 normalization was increased by 3.1-fold when the tumor invaded the cavernous sinus and increased by 9.0-fold in patients with incomplete tumor removal.

CONCLUSION:

IGF-1 level is a reliable alternative to OGTT and plays a valuable role in monitoring acromegaly status.

• Authors: In-Ho Jung, Seonah Choi, Cheol Ryong Ku, Sang-Guk Lee, Eun Jig Lee, Sun Ho Kim, Eui Hyun Kim
• Journal: The Journal of clinical endocrinology and metabolism (J Clin Endocrinol Metab) Vol. 106 Issue 7 Pg. e2589-e2599 (06 16 2021) ISSN: 1945-7197 [Electronic] United States
• PMID: 33738470 (Publication Type: Evaluation Study, Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: © The Author(s) 2021. Published by Oxford University Press on behalf of the Endocrine Society. All rights reserved. For permissions, please e-mail: [email protected].

Chemical References

• Biomarkers
• IGF1 protein, human
• Insulin-Like Growth Factor I

Topics

• Acromegaly (blood, etiology, surgery)
• Adenoma (blood, complications, surgery)
• Adult
• Biomarkers (blood)
• Female
• Glucose Tolerance Test
• Growth Hormone-Secreting Pituitary Adenoma (blood, complications, surgery)
• Humans
• Insulin-Like Growth Factor I (analysis)
• Male
• Middle Aged
• Postoperative Period
• ROC Curve
• Regression Analysis
• Remission Induction
• Reproducibility of Results
• Retrospective Studies
• Sentinel Surveillance
• Treatment Outcome