Rosario Pedro Weslley, Calsolari Maria Regina
Serviço de Endocrinologia, Santa Casa de Belo Horizonte, MG, Brasil.
Arch Endocrinol Metab. 2017 Sept-Oct;61(5):426-431. doi: 10.1590/2359-3997000000295. Epub 2017 Sep 18.
To report the results of initial investigation and after 5 years of patients with a suspicious clinical scenario for acromegaly, elevated IGF-1, and nadir GH during an oral glucose tolerance test (OGTT) > 0.4 µg/L but < 1 µg/L.
Seventeen patients who had elevated IGF-1 (outside puberty and pregnancy) in two measurements and GH between 0.4 and 1 µg/L during OGTT were selected.
During initial assessment, only one patient had microadenoma on magnetic resonance imaging (MRI) of the pituitary. In this patient, IGF-1 returned to normal spontaneously after 5 years. In the remaining 16 patients, spontaneous normalization of IGF-1 was observed in four and IGF-1 continued to be elevated in 12 after 5 years. None of the latter patients developed a phenotype of acromegaly, changes in physiognomy or increase in IGF-1 and no tumor was detected by imaging methods. Two patients had nadir GH < 0.4 µg/L, while the nadir GH remained between 0.4 and 1 µg/L in 10 patients.
In patients (notably young adult or adult women) without a typical phenotype in whom IGF-1 is measured due to a suspicious clinical scenario and is found to be slightly elevated, even if confirmed and in the absence of other causes, a nadir GH cut-off value of 0.4 µg/L instead of 1 µg/L in the OGTT might be inadequate for the diagnosis.
报告对临床怀疑肢端肥大症、胰岛素样生长因子-1（IGF-1）升高且口服葡萄糖耐量试验（OGTT）中生长激素（GH）谷值>0.4 μg/L但<1 μg/L的患者进行初始调查及5年后的结果。
选取17例IGF-1（青春期和孕期以外）两次测量值升高且OGTT期间GH在0.4至1 μg/L之间的患者。
初始评估时，仅1例患者垂体磁共振成像（MRI）显示有微腺瘤。该患者5年后IGF-1自发恢复正常。其余16例患者中，4例IGF-1自发恢复正常，12例5年后IGF-1持续升高。后一组患者均未出现肢端肥大症表型、面容改变或IGF-1升高，影像学检查未发现肿瘤。2例患者GH谷值<0.4 μg/L，10例患者GH谷值仍在0.4至1 μg/L之间。
对于临床情况可疑、测量IGF-1发现轻度升高且无典型表型的患者（尤其是年轻成年女性或成年女性），即使确诊且无其他病因，OGTT中GH谷值临界值采用0.4 μg/L而非1 μg/L进行诊断可能并不充分。
