Health Sciences University, Dışkapı Training and Research Hospital, Department of Endocrinology and Metabolism, Ankara, Türkiye.
Health Sciences University, Dışkapı Training and Research Hospital, Department of Endocrinology and Metabolism, Ankara, Türkiye.
Growth Horm IGF Res. 2022 Dec;67:101501. doi: 10.1016/j.ghir.2022.101501. Epub 2022 Sep 8.
The nadir growth hormone (nGH) during the oral glucose tolerance test (OGTT) is the gold standard method for diagnosing acromegaly. A paradoxical growth hormone (GH) response to oral glucose (OG) in acromegaly can be observed. The role of the paradoxical GH response on how the patients with acromegaly respond to the treatment has been addressed in few studies. The aim of this study was to investigate the association between glucose-dependent growth hormone results and and the responses of acromegalic patients to surgical and/or medical therapy following surgery.
This retrospective cohort study included patients with acromegaly who underwent surgery (n = 189) or received primary medical treatment (n = 9). The mean age was 50.44 ± 12.81 years (M/F: 84/114). The patients were grouped into paradoxical (GH-P) and non-paradoxical (GH-nP) according to GH response to OG and were compared in terms of clinical and pathological features, pituitary tumor size, invasiveness, biochemical profiles, and how they responded to the treatment.
The mean age, gender distribution, and basal tumor diameter were all similar in both groups (p > 0.05). The GH-P group had a higher remission rate in response to medical therapy followed by surgery (83% vs. 55%; p = 0.026). Although a higher surgical remission rate in favor of GH-P was observed, it did not reach statistical significance (63% vs. 48%; p = 0.059). Overall treatment response rates were also higher in the GH-P group compared to the GH-nP group (89% vs. 71%; p = 0.005).
A paradoxical GH response to OG load may help to predict the response to medical treatment in patients with acromegaly.
口服葡萄糖耐量试验（OGTT）期间的生长激素（GH）最低点是诊断肢端肥大症的金标准方法。在肢端肥大症中，可以观察到生长激素（GH）对口服葡萄糖（OG）的反常反应。关于GH 反应如何影响肢端肥大症患者对治疗的反应，已有少数研究对此进行了探讨。本研究旨在调查葡萄糖依赖性 GH 结果与接受手术治疗后的肢端肥大症患者对手术和/或药物治疗的反应之间的相关性。
这项回顾性队列研究纳入了接受手术（n=189）或接受初始药物治疗（n=9）的肢端肥大症患者。平均年龄为 50.44±12.81 岁（男女比例：84/114）。根据 GH 对 OG 的反应，将患者分为反常（GH-P）和非反常（GH-nP）组，并比较两组的临床和病理特征、垂体肿瘤大小、侵袭性、生化特征以及对治疗的反应。
两组的平均年龄、性别分布和基础肿瘤直径均相似（p＞0.05）。GH-P 组在接受药物治疗后再行手术的缓解率更高（83%比 55%；p=0.026）。尽管 GH-P 组的手术缓解率更高，但未达到统计学意义（63%比 48%；p=0.059）。GH-P 组的整体治疗反应率也高于 GH-nP 组（89%比 71%；p=0.005）。
OG 负荷时 GH 的反常反应可能有助于预测肢端肥大症患者对药物治疗的反应。
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