Discordant nadir GH after oral glucose and IGF-I levels on treated acromegaly: refining the biochemical markers of mild disease activity.

Biochemical markers for remission on acromegaly activity are controversial. We studied a subset of treated acromegalic patients with discordant nadir GH levels after oral glucose tolerance test (oGTT) and IGF-I values to refine the current consensus on acromegaly remission. We also compared GH results by two GH immunoassays. From a cohort of 75 treated acromegalic patients, we studied 13 patients who presented an elevated IGF-I despite post-oGTT nadir GH of < or =1 microg/l. The 12-h daytime GH profile (GH-12 h), nadir GH after oGTT, and basal IGF-I levels were studied in patients and controls. Bland-Altman method showed high concordance between GH assays. Acromegalic patients showed higher mean GH-12 h values (0.71+/-0.36 vs. 0.31+/-0.28 microg/l; p<0.05) and nadir GH after oGTT (0.48+/-0.32 vs. 0.097+/-0.002 microg/l; p<0.05) as compared to controls. Nadir GH correlated with mean GH-12 h (r=0.92, p<0.05). The mean GH-12 h value from upper 95% CI of controls (0.54 microg/l) would correspond to a theoretical normal nadir GH of < or =0.27 microg/l. Patients with GH nadir < or =0.3 microg/l had IGF-I between 100-130% ULNR (percentage of upper limit of normal range) and mean GH-12 h of 0.35+/-0.15, and patients with GH nadir >0.3 and < or =1 microg/l had IGF-I >130% ULNR and mean GH-12 h of 0.93+/-0.24 microg/l. Our data integrate daytime GH secretion, nadir GH after oGTT, and plasma IGF-I concentrations showing a continuum of mild residual activity in a subgroup of treated acromegaly with nadir GH values < or =1 microg/l. The degree of increased IGF-I levels and nadir GH after oGTT are correlated with the subtle abnormalities of daytime GH secretion.

Elias PC ，Lugao HB ，Pereira MC ，Machado HR ，Castro Md ，Moreira AC ... -  《-》

Clinical indicators of biochemical remission in acromegaly: does incomplete disease control always mean therapeutic failure?

Damjanovic SS ，Neskovic AN ，Petakov MS ，Popovic V ，Macut D ，Vukojevic P ，Joksimovic MM ... -  《CLINICAL ENDOCRINOLOGY》

Age changes the diagnostic accuracy of mean profile and nadir growth hormone levels after oral glucose in postoperative patients with acromegaly.

Colao A ，Pivonello R ，Cavallo LM ，Gaccione M ，Auriemma RS ，Esposito F ，Cappabianca P ，Lombardi G ... -  《CLINICAL ENDOCRINOLOGY》

Assessment of disease activity in treated acromegalic patients using a sensitive GH assay: should we achieve strict normal GH levels for a biochemical cure?

Costa AC ，Rossi A ，Martinelli CE Jr ，Machado HR ，Moreira AC ... -  《JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM》

Assessment of disease activity in acromegaly by means of a single blood sample: comparison of the 120th minute postglucose value with spontaneous GH secretion and with the IGF system.

Minuto F ，Resmini E ，Boschetti M ，Arvigo M ，Sormani MP ，Giusti M ，Ferone D ，Barreca A ... -  《CLINICAL ENDOCRINOLOGY》