Université Paris-Saclay, Inserm, Physiologie et Physiopathologie Endocriniennes, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, 94275 Le Kremlin-Bicêtre, France.
Service d'Endocrinologie et Maladies métaboliques, Pôle Cardio-Vasculaire et Métabolique, CHU Larrey, 31059 Toulouse Cedex, France.
J Clin Endocrinol Metab. 2022 Aug 18;107(9):e3644-e3653. doi: 10.1210/clinem/dgac385.
In patients with acromegaly on long-term treatment with long-acting somatostatin receptor ligands (SRLs), the time of blood collection for IGF-I measurement after injection is not well defined.
We aimed to assess serum IGF-I dynamics and variability in SRL-treated patients compared with surgically cured patients and healthy controls.
Thirty patients under SRLs considered controlled based on a normal previous IGF-I level, 10 patients cured by pituitary surgery, and 7 healthy subjects underwent 4 weekly IGF-I determinations.
In SRL-treated patients, the IGF-I SDS (mean ± SD) was higher just before injection (0.34 ± 0.66) than at Day 7 (-0.33 ± 0.61; P = 0.0041) and Day 14 (-0.23 ± 0.60; P = 0.047) after injection, but it did not significantly vary in cured patients and healthy controls. The IGF-I CV was higher in SRL-treated patients than in cured patients or healthy controls (14.4 ± 7.6% vs 7.9 ± 4.4% and 8.3 ± 3.2%, respectively; P < 0.05 for both). Among SRL-treated patients, IGF-I CV was higher in "nonoptimally controlled patients"-i.e., patients with at least one elevated IGF-I value out of 4 (n = 9) compared with "optimally controlled" patients for whom all 4 IGF-I SDS values were < 2.0 (21.3 ± 9.3 vs 11.6 ± 6.0%; P = 0.0019). The latter did not differ from surgically cured patients and healthy controls. The measurement at the farthest distance from the SRL injection was the most predictive of patients with nonoptimally controlled disease.
In patients treated with long-acting SRLs, IGF-I sampling at the farthest distance from SRL injection is the most informative and best predictor of optimal disease control.
在接受长效生长抑素受体配体（SRL）治疗的肢端肥大症患者中，IGF-I 采血时间在注射后并未得到很好的定义。
我们旨在评估与经手术治愈的患者和健康对照相比，SRL 治疗患者的血清 IGF-I 动力学和变异性。
30 例根据之前正常 IGF-I 水平被认为得到控制的 SRL 治疗患者、10 例经垂体手术治愈的患者和 7 例健康受试者接受了 4 次每周 IGF-I 测定。
在 SRL 治疗的患者中，IGF-I SDS（均值±标准差）在注射前（0.34±0.66）高于第 7 天（-0.33±0.61；P=0.0041）和第 14 天（-0.23±0.60；P=0.047），但在治愈的患者和健康对照组中没有显著变化。IGF-I 的变异系数（CV）在 SRL 治疗的患者中高于治愈的患者或健康对照组（分别为 14.4±7.6%、7.9±4.4%和 8.3±3.2%；两者均 P<0.05）。在 SRL 治疗的患者中，IGF-I CV 在“非最佳控制患者”中更高，即 4 次 IGF-I SDS 值中至少有一次升高（n=9），而对于所有 4 次 IGF-I SDS 值均<2.0 的“最佳控制患者”则较低（21.3±9.3 比 11.6±6.0%；P=0.0019）。后者与经手术治愈的患者和健康对照组无差异。距离 SRL 注射最远的测量值最能预测非最佳控制疾病的患者。
在接受长效 SRL 治疗的患者中，距离 SRL 注射最远的 IGF-I 采样是最具信息量和最佳疾病控制预测值的方法。
