Dal Jakob, Klose Marianne, Heck Ansgar, Andersen Marianne, Kistorp Caroline, Nielsen Eigil H, Bollerslev Jens, Feldt-Rasmussen Ulla, Jørgensen Jens O L
Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark.
Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark.
Eur J Endocrinol. 2018 Jan;178(1):65-74. doi: 10.1530/EJE-17-0546. Epub 2017 Oct 9.
Discordant GH and IGF-I values are frequent in acromegaly. The clinical significance and its dependence on treatment modality and of glucose-suppressed GH (GH) measurements remain uncertain.
To evaluate the effects of targeting IGF-I GH during somatostatin analogue (SA) treatment.
84 patients with controlled acromegaly after surgery ( = 23) or SA ( = 61) underwent a GH profile including an OGTT, at baseline and after 12 months. SA patients were randomized to monitoring according to either IGF-I ( = 33) or GH ( = 28). SA dose escalation was allowed at baseline and 6 months.
GH and IGF-I at baseline and 12 months, and disease-specific Quality of Life (QoL).
IGF-I and fasting GH levels were comparable between the surgery and the SA group, whereas GH (µg/L) was lower in the surgery group (GH 0.7 ± 0.1 vs 0.3 ± 0.1, < 0.01). SA dose increase was performed in 20 patients in the GH group and in 8 patients in the IGF-I group ( = 0.02), which increased the number of concordantly controlled patients ( = 0.01). QoL was only mildly affected at baseline in all groups and did not changed consistently during the study.
(1) Discordant values in terms of high GH levels are prevalent in SA patients and more so if applying glucose-suppressed GH; (2) targeting discordant levels of either GH or IGF-I translates into SA dose increase and improved biochemical control; (3) even though QoL was not improved in this study, we suggest biochemical assessment of disease activity to include glucose-suppressed GH also in SA patients.
肢端肥大症患者中生长激素（GH）和胰岛素样生长因子-1（IGF-I）值不一致的情况很常见。其临床意义以及对治疗方式和葡萄糖抑制生长激素（GH）测量的依赖性仍不确定。
评估在生长抑素类似物（SA）治疗期间以IGF-I或GH为靶点的效果。
84例术后（n = 23）或接受SA治疗（n = 61）且病情得到控制的肢端肥大症患者在基线和12个月时进行了包括口服葡萄糖耐量试验（OGTT）在内的GH谱检查。SA治疗的患者根据IGF-I（n = 33）或GH（n = 28）随机分组进行监测。在基线和6个月时允许增加SA剂量。
基线和12个月时的GH和IGF-I，以及疾病特异性生活质量（QoL）。
手术组和SA组之间的IGF-I和空腹GH水平相当，而手术组的GH（μg/L）较低（GH 0.7±0.1 vs 0.3±0.1，P<0.01）。GH组有20例患者增加了SA剂量，IGF-I组有8例患者增加了SA剂量（P = 0.02），这增加了生化指标得到一致控制的患者数量（P = 0.01）。所有组在基线时QoL仅受到轻微影响，且在研究期间未持续变化。
（1）SA治疗的患者中，GH水平高导致的值不一致很普遍，应用葡萄糖抑制GH时更是如此；（2）针对GH或IGF-I的不一致水平进行治疗可转化为SA剂量增加和生化控制改善；（3）尽管本研究中QoL没有改善，但我们建议对疾病活动进行生化评估时，SA治疗的患者也应包括葡萄糖抑制GH。
