肢端肥大症放疗患者的生长激素缺乏：生长激素刺激试验与24小时生长激素分泌的关系及意义

GH deficiency in patients irradiated for acromegaly: significance of GH stimulatory tests in relation to the 24 h GH secretion.

作者信息

van der Klaauw A A, Pereira A M, van Thiel S W, Smit J W A, Corssmit E P M, Biermasz N R, Frolich M, Iranmanesh A, Veldhuis J D, Roelfsema F, Romijn J A

机构信息

Department of Endocrinology, Leiden University Medical Center, Leiden, The Netherlands.

出版信息

Eur J Endocrinol. 2006 Jun;154(6):851-8. doi: 10.1530/eje.1.02163.

DOI:10.1530/eje.1.02163

PMID:16728545

Abstract

BACKGROUND

Radiotherapy for pituitary adenomas frequently leads to GH deficiency (GHD). The characteristics of GH secretion in GHD induced by postoperative radiotherapy for acromegaly are not known.

HYPOTHESIS

In the long term, stimulated and spontaneous GH release is not different between patients with GHD treated by postoperative radiotherapy for acromegaly or for other pituitary adenomas.

DESIGN/SUBJECTS: We compared the characteristics of basal and stimulated GH secretion in patients with GHD, who had previously received adjunct radiotherapy after surgery for GH-producing adenomas (n=10) vs for other pituitary adenomas (n=10). All patients had a maximal GH concentration by insulin tolerance test (ITT) of 3 microg/l or less, compatible with severe GHD. Mean time after radiation was 17 and 18.7 years, respectively. Stimulated GH release was also evaluated by infusion of growth hormone-releasing hormone (GHRH), GHRH-arginine and arginine, and spontaneous GH by 10 min blood sampling for 24 h. Pulse analyses were performed by Cluster and approximate entropy.

OUTCOMES

There were no differences between both patient groups in stimulated GH concentrations in any test. Spontaneous GH secretion was not different between both patient groups, including basal GH release, pulsatility and regularity. Pulsatile secretion was lost in two acromegalic and three non-acromegalic patients. Insulin-like growth factor-I (IGF-I) was below -2 s.d. score in nine patients in each group.

CONCLUSION

Acromegalic patients treated by surgery and postoperative radiotherapy with an impaired response to the ITT do not differ, in the long term, in GH secretory characteristics from patients treated similarly for other pituitary tumors with an impaired response to the ITT. The ITT (or the GHRH-arginine test) is therefore reliable in establishing the diagnosis of GHD in patients treated for acromegaly by surgery and radiotherapy.

摘要

背景

垂体腺瘤放疗常导致生长激素缺乏（GHD）。肢端肥大症术后放疗所致GHD患者的生长激素分泌特征尚不清楚。

假设

从长期来看，肢端肥大症或其他垂体腺瘤术后放疗所致GHD患者的刺激后和自发性生长激素释放无差异。

设计/研究对象：我们比较了生长激素分泌型腺瘤（n = 10）或其他垂体腺瘤（n = 10）术后接受辅助放疗的GHD患者基础和刺激后生长激素分泌的特征。所有患者经胰岛素耐量试验（ITT）测得的最大生长激素浓度均为3μg/L或更低，符合严重GHD。放疗后的平均时间分别为17年和18.7年。还通过输注生长激素释放激素（GHRH）、GHRH-精氨酸和精氨酸评估刺激后生长激素释放，并通过24小时内每10分钟采血一次评估自发性生长激素。采用聚类和近似熵进行脉冲分析。