D'Arcy Robert, Courtney C Hamish, Graham Una, Hunter Steven, McCance David R, Mullan Karen
Regional Centre for Endocrinology and Diabetes Royal Victoria Hospital Belfast UK.
Endocrinol Diabetes Metab. 2017 Dec 27;1(1):e00007. doi: 10.1002/edm2.7. eCollection 2018 Jan.
Recent guidelines recommend insulin-like growth factor (IGF-1), random growth hormone (GH) and nadir GH on an oral glucose tolerance test (OGTT) for assessment of acromegaly. At this Regional Centre, the 24-hour GH profile has also been used.
We evaluated 57 GH profiles from 34 patients from 2008 to 2012. Samples were drawn every 2 hour and matched with 0800 GH, nadir GH after OGTT and IGF-1.
Correlations between the mean 13-point profiles and mean 5-point profile, OGTT nadir and 0800 GH were as follows: = .99, .99 and .90, respectively ( < .01 for all). The correlation between the mean 13-point profiles and IGF-1 was = .32 = .02.Of 5 patients with very high 0800 GH preoperatively (≥20 μg/L), mean 13-point GH reduced by 88%-99% postoperatively. IGF-1 did not normalize in these patients, and all required extra treatment. Preoperatively, all patients had concordant 0800 GH and IGF-1. Postoperatively, 6 patients had 0800 GH <1 μg/L and high IGF-1; only 2 of these had a 13-point mean >1 μg/L, but 5 required further treatment.
Growth hormone profiling is not necessary for assessing the majority of patients with acromegaly if there is confidence in the local IGF-1 assay. When undertaken, a 5-point profile is adequate. In patients with very high 0800 GH, 24-hour profiling was useful in demonstrating partial therapeutic success but did not alter management. Further work is needed to explore the possible role of GH profiling in stratifying patients with discordant IGF-1 and GH results.
近期指南推荐使用胰岛素样生长因子（IGF-1）、随机生长激素（GH）以及口服葡萄糖耐量试验（OGTT）中的最低生长激素水平来评估肢端肥大症。在本地区中心，也采用了24小时生长激素谱。
设计、患者与测量：我们评估了2008年至2012年34例患者的57份生长激素谱。每2小时采集一次样本，并与08:00的生长激素水平、OGTT后的最低生长激素水平以及IGF-1进行匹配。
13点均值生长激素谱与5点均值生长激素谱、OGTT最低值以及08:00生长激素水平之间的相关性分别为：r = 0.99、0.99和0.90（均P < 0.01）。13点均值生长激素谱与IGF-1之间的相关性为r = 0.32，P = 0.02。术前5例08:00生长激素水平非常高（≥20μg/L）的患者，术后13点均值生长激素水平降低了88% - 99%。这些患者的IGF-1未恢复正常，均需要额外治疗。术前，所有患者的08:00生长激素水平和IGF-1均一致。术后，6例患者的08:00生长激素水平<1μg/L且IGF-1水平较高；其中只有2例的13点均值>1μg/L，但5例仍需要进一步治疗。
如果对当地的IGF-1检测有信心，对于大多数肢端肥大症患者，无需进行生长激素谱分析。若进行检测，5点谱即可。对于08:00生长激素水平非常高的患者，24小时谱分析有助于证明部分治疗成功，但不会改变治疗方案。需要进一步研究以探讨生长激素谱分析在对IGF-1和生长激素结果不一致的患者进行分层方面的可能作用。
