Ukhanova Yu A, Ilovayskaya I A
Moscow Regional Research and Clinical Institute.
Probl Endokrinol (Mosk). 2023 Sep 18;70(2):4-10. doi: 10.14341/probl13344.
Hyperprolactinemia accompanies growth hormone hypersecretion in approximately 25-39% of cases. There is a recommendation to determine the level of prolactin in clinical guidelines for diagnosis and treatment of acromegaly. However, there is no understanding of the necessity to investigate the IGF-1 level in patients with hyperprolactinemia and a pituitary adenoma.
Determining the proportion of patients with hyperprolactinemia and pituitary adenoma, who were examined for IGF-1 levels, and identifying the proportion of patients with acromegaly among this cohort.
Between December 2019 and December 2022 a single-center observational single-stage single-sample uncontrolled study was conducted. At the first stage of the study, the proportion of patients with pituitary adenoma and hyperprolactinemia with studied IGF-1 levels was determined, according to medical records. At the second stage of the study, patients without known indicators of IGF-1 were determined. The concentration of growth hormone was studied during the oral glucose load in the case of increased IGF-1 levels.
At the first stage, 105 patients were included in the study. The level of IGF-1 was determined in 41/105 (39%) cases. There were 22/41 (53.7%) cases in the subgroup with pituitary incidentalomas and 19/64 (29.7%) cases in the subgroup with hyperprolactinemia among them. At the second stage, the IGF-1 level was additionally determined in 53 patients with hyperprolactinemia and pituitary adenoma (total 94 patients). The level of IGF-1 was elevated in 11/94 patients, further acromegaly was confirmed in 3/94 patients (3.2%).
In real clinical practice the level of IGF-1 is studied only in 39% of cases in patients with pituitary adenoma and hyperprolactinemia. The disease was detected in 3 cases (3.2%) out of 94 people with hyperprolactinemia and pituitary adenoma without clinical manifestations of acromegaly. We consider the study of IGF-1 levels justified as a screening for acromegaly in patients with hyperprolactinemia and pituitary adenoma.
在约25%-39%的病例中，高催乳素血症与生长激素分泌过多同时存在。在肢端肥大症的诊断和治疗临床指南中建议测定催乳素水平。然而，对于高催乳素血症和垂体腺瘤患者中检测胰岛素样生长因子-1（IGF-1）水平的必要性尚无认识。
确定检测IGF-1水平的高催乳素血症和垂体腺瘤患者的比例，并确定该队列中肢端肥大症患者的比例。
2019年12月至2022年12月进行了一项单中心观察性单阶段单样本非对照研究。在研究的第一阶段，根据病历确定垂体腺瘤和高催乳素血症且检测了IGF-1水平的患者比例。在研究的第二阶段，确定未检测IGF-1指标的患者。在IGF-1水平升高的情况下，在口服葡萄糖耐量试验期间研究生长激素浓度。
在第一阶段，105例患者纳入研究。41/105（39%）例患者测定了IGF-1水平。其中垂体偶发瘤亚组中有22/41（53.7%）例，高催乳素血症亚组中有19/64（29.7%）例。在第二阶段，另外对53例高催乳素血症和垂体腺瘤患者（共94例患者）测定了IGF-1水平。11/94例患者IGF-1水平升高，3/94例患者（3.2%）进一步确诊为肢端肥大症。
在实际临床实践中，垂体腺瘤和高催乳素血症患者中仅39%的病例检测了IGF-1水平。在94例无肢端肥大症临床表现的高催乳素血症和垂体腺瘤患者中，有3例（3.2%）检测出该病。我们认为检测IGF-1水平作为高催乳素血症和垂体腺瘤患者肢端肥大症的筛查是合理的。
