Long‐term basal and dynamic evaluation of hypothalamic–pituitary–adrenal (HPA) axis in acromegalic patients

Abstract

The HPA axis function must be carefully monitored over the time by dynamic testing in all acromegalic patients, independently from the type of treatment.

Efficacy and tolerability of gamma knife radiosurgery in acromegaly: a 10‐year follow‐up study

“…In fact, without using dynamic testing, failing adrenal and GH–IGF‐I axes might have been underestimated 13 . Furthermore, the high prevalence of hypoadrenalism might be explained by our definition of hypoadrenalism, evaluated in most patients by LDSST, a highly sensitive test able to identify even subclinical deficiencies 19,28 . In addition, this might suggest a particular frailty of this axis to GK damage, not reported previously 8,11,12 .…”

“…Thyrotrophic deficiency was defined by low free thyroxine (FT 4 ) levels with normal/low TSH levels, gonadotrophic deficiency by low/normal gonadotropin levels and low testosterone in males, amenorrhoea and low oestradiol in females. Corticotrophic failure was defined by low basal serum cortisol and/or insufficient cortisol response (cortisol peak <500 nmol/l) to the 1 μg synacthen test (LDSST), according to previously reported criteria 19 . Subclinical hypoadrenalism was defined by isolated biochemical diagnosis without clinical symptoms.…”

Comparison of primary octreotide-lar and surgical treatment in newly diagnosed patients with acromegaly

“…The other patient was a man, receiving medical treatment, showed ondulating testosteron levels, but the patient also had slight hyperprolactinemia. Gonadal functions may deteriorate, recover or not change during primary medical and surgical treatment for acromegaly 9,10,26,34–36 . The present findings reveal that both primary medical treatment and surgery are safe in terms of pituitary functions, except a slight worsening in HPA axis functions with surgery.…”

“…Secondary hypoadrenalism after long‐term follow‐up in patients with acromegaly was reported to be 32%. The deterioration in the HPA axis was attributed to the effect of neurosurgery not SSA per se 34 . HPA axis deterioration after primary medical treatment was reported to be 0–20% with varying methods, such as urinary free cortisol and basal serum cortisol, during different follow‐up periods ranging from 12 to 48 months or longer 9,10,26,35,36 …”

Long-term effects of radiotherapy on cardiovascular risk factors in acromegaly

“…In particular, previous history of acromegaly and its treatment and the complete hormonal pattern (GH, post-glucose GH nadir, IGF1, prolactin, basal thyroid, adrenal, and gonadic functions) were analyzed. Data from dynamic adrenal function assessed by the short Synacthen test (31) were included for all the patients. The stimulated GH secretion was assessed by arginine plus GH releasing hormone test (32) A series of metabolic parameters and cardiovascular risk factors, such as body mass index (BMI), fasting plasma glucose and fasting serum insulin (FG and FI), HbA1c, complete lipid profile (total cholesterol, lowdensity lipoprotein cholesterol, high-density lipoprotein cholesterol, and triglycerides), systolic and diastolic blood pressure, were also investigated.…”