GH deficiency in patients after cure of acromegaly by surgery alone

Abstract

Objective: The aim of this study was to determine the frequency and characteristics of severe GH deficiency (sGHD) in patients after treatment of acromegaly by surgery alone. Design and methods: One hundred and eighty-six patients fulfilling the criteria for cure of acromegaly were examined by GH-releasing peptide-2 stimulation test or arginine stimulation test as well as oral glucose tolerance test (GTT). In addition, the Japanese adult hypopituitarism questionnaire was completed to determine the quality of life (QoL). Results: sGHD was found in 17 patients (9.1%; the GH-deficient group), and not found in 169 patients (90.9%; the GH-sufficient group). There were no significant differences in preoperative serum GH levels, IGF1 levels, incidence of hyperprolactinemia, tumor volumes, or incidence of microadenoma between the two groups. Upon follow-up examination, IGF1 levels and Z-scores of IGF1 levels were significantly lower in the GH-deficient group than in the GH-sufficient group, whereas neither basal GH levels nor nadir GH levels during 75 g GTT were significantly different between the two groups. Moreover, sGHD patients had a substantially higher incidence of multiple pituitary failures (17.6 vs 2.4%) and dyslipidemia (60 vs 16.2%). sGHD patients had a substantially poorer conditionrelated QoL. Conclusions: This is the first large-scale, single-center, clinical study to evaluate sGHD in patients after cure of acromegaly by surgery alone. This study found that sGHD occurred in w9% of patients and assessment of GHD by stimulation tests is critical after successful treatment of acromegaly by surgery.

Clinical predictors of GH deficiency in surgically cured acromegalic patients

“…Even in the GH axis, there was no difference in the incidence of development of GHD, compared with other studies (23,24). Specifically, the incidence of GHD was 9.8% in this study, compared with 6.1 and 9.1% in other studies (17,18). Considering the role of the pituitary gland as a center of the hormone system, acromegalic patients with GH-secreting pituitary adenoma might exhibit different changes in the GH axis after achieving biochemical remission via TSA.…”

“…The differences in prognostic factors for GHD might be caused by the characteristics of the enrolled patients and the extent of surgical resection of the GH-secreting pituitary adenomas. The age of the patients was 44 (range: 21-69) years in this study, which is about 10 years younger than those patients in previous studies (17,18). Younger age means that enrolled patients had shorter periods of acromegaly than those patients in previous studies.…”

“…Only two reports have evaluated GHD after TSA in patients with acromegaly (17,18). Their studies used GHRH plus arginine stimulation tests to confirm the diagnosis of GHD in a cross-sectional study design.…”

Impact of adult growth hormone deficiency on metabolic profile and cardiovascular risk [Review]

“…Also, the acromegaly-related cardiac abnormalities could worsen after the development of GHD [101]. However, clinical studies do not fully confirm these theoretical hypotheses, as they found a BMI slightly increased [102][103][104] or, even, similar [105][106][107][108] in acroGHD compared to GHD and acromegalic populations. At the same time, while one work reported that acroGHD patients were more hypertensive, dyslipidemic, and diabetic than GHD subjects [109], other Authors pointed out a comparable prevalence of glucose abnormalities and dyslipidemia, as well as a similar amount of body fat and lean mass between acroGHD and refcerebrovascular [5, [82][83][84][85][86][87].…”

Low insulin resistance after surgery predicts poor GH suppression one year after complete resection for acromegaly: a retrospective study

“…Furthermore, it may be that with normalized IGF-1 levels, lowering the GH nadir may be unsafe as it may indicate GH deficiency [30]. In support of this, Yamada et al reported that severe GH deficiency was present in 9.1% of patients cured of acromegaly [31]. Therefore, titration of additional therapy must definitely be considered in patients with symptoms or morbidities of acromegaly.…”