Department of Endocrinology, Imperial College London, Faculty of Medicine, Hammersmith Hospital, London, UK.
Clin Endocrinol (Oxf). 2011 Aug;75(2):220-5. doi: 10.1111/j.1365-2265.2011.04019.x.
Acromegaly is characterized by the hypersecretion of growth hormone (GH) and insulin-like growth factor-1 (IGF-1). This leads to an increased cardiovascular, cerebrovascular and metabolic morbidity resulting in excess mortality. There is controversy over which biomarker, GH or IGF-1, better predicts this increased morbidity and mortality. The relationship between the cumulative exposure to GH and IGF-1 with co-morbidities in acromegaly has not previously been reported.
To investigate the relationship between the cumulative exposure to GH and IGF-1 with cardiovascular, cerebrovascular and metabolic co-morbidities.
Records of 116 acromegalic patients were retrospectively examined. Cardiovascular and cerebrovascular histories, serum GH and IGF-1, fasting glucose and oral glucose tolerance test results, were reviewed for the duration of follow-up. IGF-1 index was calculated by dividing each serum IGF-1 value by the upper limit of reference range for IGF-1. GH and IGF-1 burdens were calculated for each patient by multiplying known disease duration (in years) by mean level of basal GH or IGF-1 index recorded during the patients' entire follow-up.
Patients with abnormal glucose tolerance had a significantly higher mean GH burden compared with euglycaemic patients (P = 0·005). Ischaemic heart disease was also associated with a higher GH burden (P = 0·009) whereas cerebrovascular disease and cardiomyopathy were associated with a significantly higher mean IGF-1 burden (P = 0·018, P = 0·011 respectively).
This study identifies associations of raised GH and IGF-1 burden with cardiovascular, cerebrovascular and metabolic complications of acromegaly. Results from this study therefore suggest that consideration of the overall level of GH and IGF-1 exposure may provide important information for the management and surveillance of patients with treated acromegaly.
肢端肥大症的特征是生长激素（GH）和胰岛素样生长因子-1（IGF-1）的过度分泌。这导致心血管、脑血管和代谢发病率增加，从而导致死亡率增加。关于哪种生物标志物（GH 或 IGF-1）能更好地预测这种发病率和死亡率的增加存在争议。GH 和 IGF-1 的累积暴露与肢端肥大症的合并症之间的关系以前没有报道过。
研究 GH 和 IGF-1 的累积暴露与心血管、脑血管和代谢合并症之间的关系。
回顾性检查了 116 例肢端肥大症患者的记录。在随访期间，回顾了心血管和脑血管病史、血清 GH 和 IGF-1、空腹血糖和口服葡萄糖耐量试验结果。IGF-1 指数通过将每个血清 IGF-1 值除以 IGF-1 的参考范围上限来计算。通过将已知的疾病持续时间（以年为单位）乘以患者整个随访期间记录的基础 GH 或 IGF-1 指数的平均水平，计算每位患者的 GH 和 IGF-1 负担。
糖耐量异常患者的平均 GH 负担明显高于血糖正常患者（P=0·005）。缺血性心脏病也与较高的 GH 负担相关（P=0·009），而脑血管疾病和心肌病与较高的平均 IGF-1 负担相关（P=0·018，P=0·011）。
本研究确定了升高的 GH 和 IGF-1 负担与肢端肥大症的心血管、脑血管和代谢并发症之间的关联。因此，本研究的结果表明，考虑 GH 和 IGF-1 暴露的整体水平可能为治疗后肢端肥大症患者的管理和监测提供重要信息。
