Random Gh and Igf-I levels after transsphenoidal surgery for acromegaly: relation with long-term remission

Cunha, Marcelo Lemos Vieira da; Borba, Luis A. B.; Boguszewski, César Luiz

doi:10.1007/s12020-020-02227-2

Cited by 12 publications

(8 citation statements)

References 39 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Comparable to our POD1 GH cutoff of ≥1.55ng/mL, Cunha et al. found a postoperative random GH level of ≥1.7 ng/ml as a reliable indicator of surgical failure in their patients, though the timeline of GH sampling was unclear ( 20 ). Other studies have suggested POD1 GH cutoffs of 2.5ng/mL ( 23 ) and 2.33ng/mL ( 14 ) to predict postoperative remission, though these higher values reduced the sensitivity while raising the specificity of the cutoff.…”

Section: Discussionmentioning

confidence: 53%

“…Besides the updated use of corrected IGF-1 levels, an important distinction between our findings and Hazer et al's is the timing of the measurement of postoperative IGF-1 levels (1 month vs. between 6-12 weeks). While IGF-1 levels have been found to fluctuate up to 3 months following resection (20,21), further studies are merited to explore the optimal window for using IGF-1 reduction as a predictor of surgical outcome. Additionally, the use of corrected IGF-1 values using the upper limit of normal enhances our ability to compare values between individuals and across age-related changes in the normal range (22).…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Postoperative GH and Degree of Reduction in IGF-1 Predicts Postoperative Hormonal Remission in Acromegaly

et al. 2021

View full text Add to dashboard Cite

PurposeDetermine predictive factors for long-term remission of acromegaly after transsphenoidal resection of growth hormone (GH)-secreting pituitary adenomas.MethodsWe identified 94 patients who had undergone transsphenoidal resection of GH-secreting pituitary adenomas for treatment of acromegaly at the USC Pituitary Center from 1999-2019 to determine the predictive value of postoperative endocrine lab values.ResultsPatients underwent direct endoscopic endonasal (60%), microscopic transsphenoidal (38%), and extended endoscopic approaches (2%). The cohort was 63% female and 37% male, with average age of 48.9 years. Patients presented with acral enlargement (72, 77%), macroglossia (40, 43%), excessive sweating (39, 42%), prognathism (38, 40%) and frontal bossing (35, 37%). Seventy-five (80%) were macroadenomas and 19 (20%) were microadenomas. Cavernous sinus invasion was present in 45%. Available immunohistochemical data demonstrated GH staining in 88 (94%) and prolactin in 44 (47%). Available postoperative MRI demonstrated gross total resection in 63% of patients and subtotal resection in 37%. Most patients (66%) exhibited hormonal remission at 12 weeks postoperatively. Receiver operating characteristic (ROC) curves demonstrated postoperative day 1 (POD1) GH levels ≥1.55ng/mL predicted failure to remit from surgical resection alone (59% specificity, 75% sensitivity). A second ROC curve showed decrease in corrected insulin-like growth factor-1 (IGF-1) levels of at least 37% prognosticated biochemical control (90% sensitivity, 80% specificity).ConclusionPOD1 GH and short-term postoperative IGF-1 levels can be used to successfully predict immediate and long-term hormonal remission respectively. A POD1 GH cutoff can identify patients likely to require adjuvant therapy to emphasize clinical follow-up.

show abstract

Section: Discussionmentioning

confidence: 53%

Section: Discussionmentioning

confidence: 99%

Postoperative GH and Degree of Reduction in IGF-1 Predicts Postoperative Hormonal Remission in Acromegaly

et al. 2021

View full text Add to dashboard Cite

show abstract

“…Suppression was traditionally defined as GH nadir of less than 1.0 ng/mL (<1.0 μg/L) after OGTT, but now with ultrasensitive assays, the consensus for suppression is a GH level of less than 0.4 ng/mL (<0.04 μg/L) [ 6 ]. There was also a retrospective study of postsurgical patients with a mean follow-up of 39 months that suggests a 3-month IGF-1 level less than 1.25 times the upper limit of normal is associated with long-term remission [ 3 ]. There are also other factors that can affect GH and IGF-1 levels, such as pregnancy, diabetes, oral estrogen (not transdermal estrogen), and critical illness [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

“…In addition to the challenge of diagnosing both conditions simultaneously, the presence of both causes a laboratory dilemma. Biochemical control following treatment of a somatotroph adenoma is characterized by growth hormone (GH) suppression during an oral glucose tolerance test (OGTT) and normalization of age-adjusted insulin-like growth factor 1 (IGF-1) levels [ 3 ]. There is limited information on how hypercortisolism affects these tests, but there are some study data that suggest patients with Cushing syndrome have elevated IGF-1 compared to controls [ 4 , 5 ].…”

Section: Introductionmentioning

confidence: 99%

A Rare Case When Acromegaly Meets Cushing Syndrome

Gabbay,

Steinmetz-Wood,

Chamorro-Pareja

et al. 2023

JCEM Case Reports

View full text Add to dashboard Cite

Acromegaly is very uncommon, as is non-iatrogenic Cushing syndrome; we discuss a patient who was found to have both a pituitary adenoma causing acromegaly and a cortisol-producing adrenal adenoma causing Cushing syndrome within 1 year. She was a healthy, 44-year-old woman who presented with visual changes and was found to have bitemporal hemianopsia and a 3.3-cm pituitary mass along with central hypogonadism, central hypothyroidism, and suppressed adrenocorticotropin and discrepant cortisol. After transsphenoidal resection she had declining, but persistently elevated, insulin-like growth factor 1 (IGF-1), raising concern for persistent acromegaly. She also was experiencing several cushingoid symptoms and was found to have elevated salivary and urinary cortisol. An abdominal computed tomography scan showed a 3.1-cm adrenal adenoma, and she subsequently underwent adrenalectomy. Following adrenalectomy, her cortisol levels normalized, and her IGF-1, growth hormone, and oral glucose tolerance test showed substantial improvement consistent with previous reports linking hypercortisolism and elevated IGF-1 levels. Combinations of pituitary and adrenal disease are seen in a handful of genetic syndromes; however, her clinical presentation and genetics do not fit with known syndromes. This case describes two rare endocrine tumors in one patient and associated limitations of routine laboratory testing.

show abstract

“…Variables considered as possible predictors for remission and relapse after TSS were selected based on previous studies (8,(15)(16)(17)(18), biological plausibility, and availability of robust data ascertainment in the 3 cohorts and included age at diagnosis and surgery, sex, serum (nadir) GH and IGF-1 concentration at diagnosis, tumor size (micro-or macroadenoma at diagnosis), cavernous sinus invasion (Knosp 3 or 4) ( 11), and use of preoperative medical therapy (DA, SSA-1, SSA-2, GHRA). In analysis of serum IGF-1 and GH postoperatively, only those values that were measured at least 12 weeks after surgery were analyzed.…”

Section: Candidate Predictorsmentioning

confidence: 99%

Predictors for remission after transsphenoidal surgery in acromegaly: A dutch multicenter study

Coopmans¹,

Postma²,

Wolters³

et al. 2020

EJEA

View full text Add to dashboard Cite

show abstract

Random Gh and Igf-I levels after transsphenoidal surgery for acromegaly: relation with long-term remission

Cited by 12 publications

References 39 publications

Postoperative GH and Degree of Reduction in IGF-1 Predicts Postoperative Hormonal Remission in Acromegaly

Postoperative GH and Degree of Reduction in IGF-1 Predicts Postoperative Hormonal Remission in Acromegaly

A Rare Case When Acromegaly Meets Cushing Syndrome

Predictors for remission after transsphenoidal surgery in acromegaly: A dutch multicenter study

Contact Info

Product

Resources

About