Abstract | CONTEXT: OBJECTIVE: To evaluate the impact of different GH cutoffs on discordance rate. To investigate whether the mean of consecutive GH measurements impacts discordance rate when matched to the last available IGF-1 value. DESIGN: Retrospective study. SETTING: PATIENTS: Ninety acromegaly patients with at least 3 consecutive evaluations for GH and IGF-1 using the same assay in the same laboratory (median follow-up 13 years). INTERVENTIONS: MAIN OUTCOME MEASURES: Single fasting GH (GHf) and IGF-1 (IGF-1f). Mean of 3 GH measurements (GHm), collected during consecutive routine patients' evaluations. RESULTS: At last evaluation GHf values were 1.99 ± 2.79 µg/L and age-adjusted IGF-1f was 0.86 ± 0.44 × upper limit of normality (mean ± SD). The discordance rate using GHf was 52.2% (cutoff 1 µg/L) and 35.6% (cutoff 2.5 µg/L) (P = 0.025). "High GH" discordance was more common for GHf <1.0 µg/L, while "high IGF-1" was predominant for GHf <2.5 µg/L (P < 0.0001). Using GHm mitigated the impact of GH cutoffs on discordance (GHm <1.0 µg/L: 43.3%; GHm <2.5 µg/L: 38.9%; P = 0.265). At receiver-operator characteristic curve (ROC) analysis, both GHf and GHm were poor predictors of IGF-1f normalization (area under the curve [AUC] = 0.611 and AUC = 0.645, respectively). The prevalence of disease-related comorbidities did not significantly differ between controlled, discordant, and active disease patients. DISCUSSION: GH/IGF-1 discordance strongly depends on GH cutoffs. The use of GHm lessen the impact of GH cutoffs. Measurement of fasting GH levels (both GHf and GHm) is a poor predictor of IGF-1f normalization in our cohort.
|
Authors | Claudia Campana, Francesco Cocchiara, Giuliana Corica, Federica Nista, Marica Arvigo, Jessica Amarù, Diego Criminelli Rossi, Gianluigi Zona, Diego Ferone, Federico Gatto |
Journal | The Journal of clinical endocrinology and metabolism
(J Clin Endocrinol Metab)
Vol. 106
Issue 3
Pg. 789-801
(03 08 2021)
ISSN: 1945-7197 [Electronic] United States |
PMID | 33236108
(Publication Type: Journal Article)
|
Copyright | © The Author(s) 2020. Published by Oxford University Press on behalf of the Endocrine Society. All rights reserved. For permissions, please e-mail: [email protected]. |
Chemical References |
- IGF1 protein, human
- Human Growth Hormone
- Insulin-Like Growth Factor I
|
Topics |
- Acromegaly
(blood, therapy)
- Adenoma
(metabolism, therapy)
- Adult
- Aged
- Area Under Curve
- Cohort Studies
- Diagnostic Techniques, Endocrine
(standards)
- Female
- Growth Hormone-Secreting Pituitary Adenoma
(metabolism, therapy)
- Human Growth Hormone
(analysis, blood)
- Humans
- Insulin-Like Growth Factor I
(analysis, metabolism)
- Italy
- Male
- Middle Aged
- Reference Values
- Retrospective Studies
- Treatment Outcome
|