Zeinalizadeh Mehdi, Habibi Zohreh, Fernandez-Miranda Juan C, Gardner Paul A, Hodak Steven P, Challinor Sue M
Department of Neurological Surgery, Imam Khomeini Hospital, Tehran University of Medical Sciences, 1419733141, Tehran, Iran,
Pituitary. 2015 Feb;18(1):48-59. doi: 10.1007/s11102-014-0556-y.
Follow-up management of patients with acromegaly after pituitary surgery is performed by conducting biochemical assays of growth hormone (GH) and insulin-like growth factor-1 (IGF1). Despite concordant results of these two tests in the majority of cases, there is increasing recognition of patients who show persistent or intermittent discordance between GH and IGF1 (normal GH and elevated IGF1 or vice versa).
In this narrative review, the last three decades materials on the issue of discrepancy between GH and IGF1 were thoroughly assessed.
Various studies have obtained different discordance rates, ranging from 5.4 to 39.5%. At present, despite the use of current sensitive assays and more stringent criteria to define remission, the rate of discordance still remains high. A number of mechanisms have been proposed to explain the postoperative discordance of GH and IGF1 including; altered dynamics of the GH secretion after surgery, early postoperative hormone assay, inaccurate or less sensitive tests and laboratory errors, too high cut-off point for GH suppression in the GH assays, GH nadir values not adjusted to age, sex, and body mass index, the influence of concomitant medication, co-existing physiologic and pathologic conditions, and many other proposed reasons. Nevertheless, the underlying mechanisms are still far from clear, and the solution continues to evade complete elucidation. Similarly, the impacts of such a discrepancy over mortality and morbidity and the risk of biochemical and/or clinical recurrence are unclear.
As a challenging clinical problem, a stepwise evaluation and management of these patients appears to be more rational.
垂体手术后肢端肥大症患者的随访管理通过对生长激素（GH）和胰岛素样生长因子-1（IGF1）进行生化检测来进行。尽管在大多数情况下这两项检测结果一致，但越来越多的患者被发现GH和IGF1之间存在持续或间歇性不一致（正常GH和升高的IGF1，或反之亦然）。
在这篇叙述性综述中，对过去三十年中关于GH和IGF1差异问题的资料进行了全面评估。
各种研究得出了不同的不一致率，范围从5.4%到39.5%。目前，尽管使用了当前敏感的检测方法和更严格的缓解定义标准，但不一致率仍然很高。已经提出了许多机制来解释GH和IGF1术后的不一致，包括：手术后GH分泌动力学改变、术后早期激素检测、检测不准确或敏感性较低以及实验室误差、GH检测中GH抑制的截断点过高、GH最低点值未根据年龄、性别和体重指数进行调整、伴随用药的影响、并存的生理和病理状况以及许多其他提出的原因。然而，潜在机制仍远未明确，解决方案仍未完全阐明。同样，这种差异对死亡率和发病率以及生化和/或临床复发风险的影响尚不清楚。
作为一个具有挑战性的临床问题，对这些患者进行逐步评估和管理似乎更为合理。
