Determinants of Survival in Treated Acromegaly in a Single Center: Predictive Value of Serial Insulin-Like Growth Factor I Measurements

Biermasz, Nienke R.; Dekker, Friedo W.; Pereira, Alberto M.; Thiel, Sjoerd W. van; Schutte, Pieter J.; Dulken, H. van; Romijn, Johannes A.; Roelfsema, Ferdinand

doi:10.1210/jc.2003-032041

Cited by 183 publications

(157 citation statements)

References 20 publications

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“…Ten percent of the patients present with overt heart failure. Treatment of growth hormone (GH) excess can reduce mortality to that of the normal population (2) and reverse heart failure and myocardial hypertrophy, but valvular regurgitation persists, or even aggravates, when disease activity is insufficiently controlled (3,4). The pathophysiology of these cardiac complications of acromegaly is incompletely understood.…”

Section: Introductionmentioning

confidence: 99%

Increased aortic root diameters in patients with acromegaly

Klaauw¹,

Bax²,

Smit³

et al. 2008

European Journal of Endocrinology

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Objective: The clinical manifestations of acromegalic cardiomyopathy include arrhythmias, valvular regurgitation, concentric left ventricular (LV) hypertrophy, and LV systolic and diastolic dysfunction. At present, it is unknown whether acromegaly also affects the aortic root. Design: Aortic root diameters were prospectively assessed in 37 acromegalic patients (18 patients with active disease and 19 with controlled disease) by conventional two-dimensional and Doppler echocardiography before, and after, an observation period of 1.9 years (range 1.5-3.0 years). Baseline parameters were compared with healthy controls. Results: The diameters of the aortic root at the sino-tubular junction and the ascending aorta were increased in patients with acromegaly: 30G4 vs 26G3 mm (PZ0.0001) and 33G5 vs 30G4 mm (PZ0.006) respectively. The diameter of the aortic root at the aortic annulus and aortic sinus were not different from controls. During follow-up, the aortic root diameters increased at the levels of the annulus and the sinotubular junction (PZ0.025 and PZ0.024 respectively), whereas there was no change in the diameters at the levels of the sinus and the ascending aorta during follow-up. Baseline aortic root diameters were not influenced by disease duration, current disease activity, or blood pressure. When patients with active and inactive disease were analyzed separately, only the diameter of the sinotubular junction increased in patients with inactive acromegaly during follow-up (PZ0.031). Conclusion: Aortic root diameters are increased in patients with acromegaly compared with healthy controls.European Journal of Endocrinology 159 97-103

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Section: Introductionmentioning

confidence: 99%

Increased aortic root diameters in patients with acromegaly

Klaauw¹,

Bax²,

Smit³

et al. 2008

European Journal of Endocrinology

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“…Dados epidemiológicos derivados basicamente de RIEs policlonais demonstram que a taxa de mortalidade na acromegalia é normalizada quando o valor médio do GH está abaixo de 2,5 µg/l (31,(33)(34)(35). No entanto, utilizar esse dado epidemiológico como guia para o tratamento atual é problemático porque, para qualquer amostra de GH a ser dosada pelos imunoensaios mais sensíveis, os valores de GH serão significativamente menores aos determinados por RIE policlonal (35)(36)(37)(38)(39)(40). Embora vários valores tenham sido propostos como mais adequados para cada ensaio, não existem dados epidemiológicos até o momento que corroborem estes valores (tabela 3) (13,15,36).…”

Section: Critérios De Curaunclassified

“…Com o advento de ensaios confiáveis, o IGF-I está fazendo parte da avaliação nos distúrbios relacionados ao GH (14,24,29,31,(37)(38)(39)(40)(41)(42)(43)(44), está elevado em pacientes com acromegalia em atividade e normaliza após tratamento adequado. As vantagens da medida do IGF-I, em comparação à medida do GH, consistem na facilidade de dosagem, pois é necessária somente uma coleta, e no fato de que, por ter meia-vida longa, representa mais adequadamente os níveis de GH do que uma única medida aleatória de GH (49).…”

Section: Insulin Growth Factor I (Igf-i)unclassified

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Ensaios para a medida de hormônio do crescimento (GH) e IGF-I: aspectos metodológicos e suas implicações no diagnóstico e seguimento da acromegalia

Casagrande

Czepielewski

2007

Arq Bras Endocrinol Metab

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RESUMOA dosagem do GH no soro é essencial para confirmar ou excluir o seu excesso. Na acromegalia, a ausência de critérios clínicos suficientemente sensíveis para monitorizar o sucesso do tratamento faz com que o GH sérico seja o procedimento de escolha e, para isso, é essencial que a sua dosagem seja realizada de forma confiável, capaz de permitir interpretações uniformes. Vários critérios hormonais têm sido propostos para caracterizar remissão da acromegalia, incluindo níveis séricos de GH randômico inferior a 2,5 µg/l, nadir de GH durante o teste de tolerância oral a glicose inferior a 1,0 µg/l e IGF-I normal para sexo e idade. A importância do tratamento adequado consiste na possibilidade de reverter a mortalidade prematura da acromegalia através da diminuição dos níveis de GH para valores menores que 2,5 µg/l. Com o surgimento de ensaios ultra-sensíveis para medida do GH, tornaram-se necessários critérios mais estritos para determinar cura ou remissão da doença. Nesta revisão, descreveremos aqui as modificações decorrentes da evolução dos ensaios, as conseqüências nos resultados de GH e os pontos de corte propostos na literatura para caracterização da atividade e remissão da acromegalia. ABSTRACT Growth Hormone (GH) and IGF-I Assays: Methodological Aspects and its Implications in Acromegaly Diagnosis and Follow-Up.Growth hormone quantification in serum is essential for confirming or ruling out its excess. The absence of clinical criteria sufficiently sensitive to evaluate the treatment success enables GH as the key diagnostic procedure and for that, its measurements must be done in a reliable way and must allow uniform interpretation. Several different biochemical criteria for remission have been suggested in the past, including a random GH measurement less than 2.5 µg/l, mean GH value from a day curve less than 2.5 µg/l, nadir GH value after an oral glucose tolerance test (OGGT) less than 1.0 µg/l and a normal age-related IGF-I level. The importance of adequate treatment is highlighted by data indicating that lowering GH levels to less than 2.5 µg/l reverses the premature mortality of acromegaly. With the advances of ultrasensitive assays for GH measurement, strictest remission criteria to determine remission or cure were necessary. In this review, we describe the changes of assay methodology and its consequences in serum GH results and cut off point values to define activity and remission of acromegaly.

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“…Parmi les différents facteurs influençant cette morbidité et mortalité, on note la durée de l'affection avant son diagnostic et son traitement et la qualité du contrôle de l'hypersécrétion somatotrope. Différentes études montrent que l'IGF-I est un facteur prédictif majeur de mortalité chez les patients acromé-gales et que la normalisation de l'IGF-I permet d'amé-liorer leur pronostic vital en ramenant leur espérance de vie à un niveau comparable à celui de la population générale [30][31][32]. Chez l'enfant, un traitement substitutif par la GH recombinante (environ 0,2 mg/kg/semaine) est instauré dans les cas de déficits hypophysaires pour éviter un retard statural, qui, pour certains, pourrait être très important (taille aux alentours de 1,30 m).…”

Section: Vieillissement Humain Et Hormone De Croissanceunclassified