Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark.
Steno Diabetes Centre North Jutland, Aalborg, Denmark.
Clin Endocrinol (Oxf). 2023 Jan;98(1):74-81. doi: 10.1111/cen.14750. Epub 2022 May 4.
Active acromegaly is subject to sex differences in growth hormone (GH) and Insulin like growth factor 1 (IGF-I) patterns as well as clinical features but whether this also pertains to controlled disease is unclear.
In a cross-sectional, multi-centre study, 84 patients with acromegaly (F = 43, M = 41), who were considered controlled after surgery alone (n = 23) or during continued somatostatin receptor ligand (SRL) treatment (n = 61), were examined.
Serum concentrations of GH, insulin, glucose and free fatty acid (FFA) were measured during an oral glucose tolerance test (OGTT) together with baseline serum IGF-I and completion of two HR-Qol questionnaires (acromegaly quality of life questionnaire [AcroQol] and Patient-assessed Acromegaly Symptom Questionnaire [PASQ]).
The mean age at the time of the study was 57 (±1.1) years and the majority of females (were postmenopausal. Females had significantly higher fasting GH but comparable IGF-I standard deviation scores (SDS). Using fasting GH < 1.0 µg/L as cut off, disease control was less prevalent in females (F: 56% vs. M: 83%, p = .007) whereas a comparable figure was observed using IGF-I SDS < 2 (F:79% vs. M:76%, p = .71). Compared with males, female patients showed impaired AcroQol physical score (p = .05), higher fasting FFA (p = .03) and insulin concentrations during the OGTT (p = .04).
In patients with acromegaly considered controlled, postmenopausal females exhibited higher GH levels than males despite comparable IGF-I levels, which also translated into impaired metabolic health and well-being. Our findings point to the relevance of including GH measurements in the assessment of disease control and suggest that disease-specific sex differences prevail after treatment.
患有肢端肥大症的患者，其生长激素（GH）和胰岛素样生长因子 1（IGF-I）模式以及临床特征存在性别差异，但这种情况是否也适用于控制疾病尚不清楚。
在一项横断面、多中心研究中，检查了 84 名肢端肥大症患者（女性=43 例，男性=41 例），这些患者仅通过手术（n=23）或在继续使用生长抑素受体配体（SRL）治疗（n=61）后被认为得到了控制。
在口服葡萄糖耐量试验（OGTT）期间测量了血清 GH、胰岛素、葡萄糖和游离脂肪酸（FFA）浓度，同时测定了基线血清 IGF-I，并完成了两项 HR-Qol 问卷（肢端肥大症生活质量问卷[AcroQol]和患者评估肢端肥大症症状问卷[PASQ]）。
研究时的平均年龄为 57（±1.1）岁，大多数女性（绝经后）。女性的空腹 GH 显著升高，但 IGF-I 标准差评分（SDS）相似。使用空腹 GH<1.0μg/L 作为截断值，女性的疾病控制率较低（F：56% vs. M：83%，p=0.007），而使用 IGF-I SDS<2 时观察到类似的结果（F：79% vs. M：76%，p=0.71）。与男性相比，女性患者的 AcroQol 身体评分较低（p=0.05），OGTT 时的空腹 FFA（p=0.03）和胰岛素浓度较高（p=0.04）。
在被认为得到控制的肢端肥大症患者中，尽管 IGF-I 水平相似，但绝经后的女性 GH 水平高于男性，这也导致了代谢健康和幸福感受损。我们的研究结果表明，在评估疾病控制时，包括 GH 测量是必要的，并表明治疗后存在与疾病相关的性别差异。
