Department of Endocrinology, University Hospital Centre Zagreb, Zagreb, Croatia.
School of Medicine, University of Zagreb, Zagreb, Croatia.
J Neuroendocrinol. 2024 Nov;36(11):e13434. doi: 10.1111/jne.13434. Epub 2024 Jul 26.
Growth hormone (GH) has a short half-life and declines abruptly following somatotropinoma surgery, enabling its prompt measurement as an indicator of surgical success. This study assesses the predictive value of early postoperative GH levels for 3-month and >1-year remission of acromegaly. We conducted a retrospective search in our database of patients who had undergone transsphenoidal surgery of GH-secreting pituitary adenoma from January 2011 to June 2022. Only the patients who underwent the first pituitary surgery and had GH measurements on the fifth postoperative day were included. The 3-month and >1-year remission of acromegaly was defined as achieving the GH nadir of <0.4 μg/L during an oral glucose tolerance test and maintaining normal insulin-like growth factor 1 levels at the initial follow-up visit 3 months after surgery and throughout at least the first year postoperation. We included 63 patients in the analysis, with a median follow-up of 51.8 (13-155) months. The 3-month remission was achieved in 42 (66.7%) patients, and >1-year remission without additional therapy in 38 (60.3%) patients. Those who achieved >1-year remission had significantly lower fifth-day postoperative GH levels (0.59 [0.09-8.92] vs. 2.63 [0.25-24.64] μg/L, p < .001). Receiver-operating characteristic analysis revealed a significant value of fifth-day postoperative GH levels regarding the prediction of 3-month (area under the curve [AUC], 0.834; p < .0001) and >1-year (AUC, 0.783; p < .0001) acromegaly remission. The GH threshold of ≤1.57 μg/L yielded a sensitivity of 90.5% and a specificity of 71.4% at 3 months and 89.5% sensitivity and 60% specificity at the >1-year remission, respectively. Notably, all patients with fifth-day postoperative GH levels ≤0.23 μg/L exhibited remission of acromegaly throughout the follow-up period. Early postoperative GH measurement could be a reliable predictor of both 3-month and >1-year remission of acromegaly.
生长激素（GH）半衰期短，在垂体瘤手术后会突然下降，因此可以迅速测量作为手术成功的指标。本研究评估了术后早期 GH 水平对肢端肥大症 3 个月和 >1 年缓解的预测价值。我们对 2011 年 1 月至 2022 年 6 月期间接受经蝶窦垂体腺瘤 GH 分泌瘤手术的患者数据库进行了回顾性检索。仅纳入在术后第 5 天进行 GH 测量且仅接受首次垂体手术的患者。肢端肥大症 3 个月和 >1 年缓解的定义为在口服葡萄糖耐量试验中 GH 谷值<0.4μg/L，并在术后 3 个月的初始随访时维持正常胰岛素样生长因子 1 水平，至少在术后第 1 年持续如此。我们纳入了 63 例患者进行分析，中位随访时间为 51.8（13-155）个月。42 例（66.7%）患者达到 3 个月缓解，38 例（60.3%）患者在无额外治疗的情况下达到 >1 年缓解。达到 >1 年缓解的患者术后第 5 天 GH 水平显著较低（0.59[0.09-8.92]vs.2.63[0.25-24.64]μg/L，p<0.001）。受试者工作特征分析显示，术后第 5 天 GH 水平对预测 3 个月（曲线下面积[AUC]，0.834；p<0.0001）和 >1 年（AUC，0.783；p<0.0001）肢端肥大症缓解具有显著价值。GH 阈值≤1.57μg/L在 3 个月时的敏感性为 90.5%，特异性为 71.4%，在 >1 年缓解时的敏感性为 89.5%，特异性为 60%。值得注意的是，所有术后第 5 天 GH 水平≤0.23μg/L 的患者在整个随访期间均缓解了肢端肥大症。术后早期 GH 测量可以可靠预测肢端肥大症 3 个月和 >1 年的缓解。
