Dutta Pinaki, Singhal Saurabh, Sachdeva Naresh Kumar, Shah Viral N, Pathak Ashish, Mukherjee K K, Bhansali Anil
J Assoc Physicians India. 2014 Aug;62(8):686-90.
Diagnosis of acromegaly in presence of uncontrolled diabetes mellitus is not well validated.
The study included 10 patients of active acromegaly with uncontrolled blood glucose, 10 patients of type 2 diabetes mellitus with poor glycemic control and 10 healthy subjects. The growth hormone level following oral glucose tolerance test and insulin-like growth factor-1 (IGF-1) and insulin-like growth factor-binding protein-3 (IGFBP-3) were done at baseline in all the 3 groups and it was repeated after short term glycemic control in type 2 diabetics and acromegalics with diabetics
In the acromegalic group the basal GH value was very high (36.5 + 1.6) ng/ml and it was non-suppressible (32.5 + 1.43) ng/ml after OGTT. The mean IGF-1 and IGFBP-3 values were also high at baseline (208.38 + 38.51) ng/ml, and 7322 + 370 ng/ml respectively. In the non-acromegalic diabetic patients, the basal growth hormone value was marginally elevated (2.3 + 0.02) ng/ml. However, it was suppressible to 0.2 + 0.04 ng/ml after oral glucose load. In them the IGF-1 and IGFBP-3 values were not elevated and comparable to that of healthy controls.
Basal serum GH and IGFBP-3 levels are not influenced by degree of glycemic control however serum IGF-1 levels should be interpreted with caution in patients of acromegaly with diabetes. Oral glucose load test has discriminating ability to diagnose acromegaly even with poorly controlled diabetes.
在存在未控制的糖尿病的情况下，肢端肥大症的诊断尚未得到充分验证。
该研究纳入了10例血糖未得到控制的活动性肢端肥大症患者、10例血糖控制不佳的2型糖尿病患者和10名健康受试者。在所有3组中，于基线时进行口服葡萄糖耐量试验后的生长激素水平以及胰岛素样生长因子-1（IGF-1）和胰岛素样生长因子结合蛋白-3（IGFBP-3）检测，并在2型糖尿病患者和合并糖尿病的肢端肥大症患者短期血糖控制后重复检测。
在肢端肥大症组中，基础生长激素值非常高（36.5 + 1.6）ng/ml，口服葡萄糖耐量试验后不可抑制（32.5 + 1.43）ng/ml。基线时IGF-1和IGFBP-3的平均水平也很高，分别为（208.38 + 38.51）ng/ml和7322 + 370 ng/ml。在非肢端肥大症糖尿病患者中，基础生长激素值略有升高（2.3 + 0.02）ng/ml。然而，口服葡萄糖负荷后可抑制至0.2 + 0.04 ng/ml。他们的IGF-1和IGFBP-3值未升高，与健康对照组相当。
基础血清生长激素和IGFBP-3水平不受血糖控制程度的影响，然而，对于合并糖尿病的肢端肥大症患者，血清IGF-1水平的解读应谨慎。口服葡萄糖负荷试验即使在糖尿病控制不佳的情况下也具有诊断肢端肥大症的鉴别能力。
