Charalampaki P, Hildebrandt G, Schaeffer H J, Schönau E, Klug N
Department of Neurosurgery, University of Cologne.
Exp Clin Endocrinol Diabetes. 1998;106(2):130-4. doi: 10.1055/s-0029-1211964.
Disease activity in acromegaly is accurately reflected by growth hormone (GH) concentration during oral glucose tolerance test (OGTT) and insulin-like growth factor-I (IGF-I) levels, representing an integrated index of GH activity. This prospective study was performed to evaluate whether plasma IGF binding protein 3 (IGFBP-3) might also reflect the hormonal disease activity in pituitary acromegaly after operative treatment during early and late follow-up. Twenty-two acromegalic patients were studied. Data were obtained pre-, intra- and post-operatively in 13 cases. In 9 patients the acromegalic activity was studied only after treatment. The hormonal assessment included repeated blood samples for estimation of IGF-I, IGFBP-3 and repeated OGTTs. In each case 100 sigma g octreotide (Sandostatin lambda, Sandoz, Basel) was injected to test the acute response of GH, IGF-I and IGFBP-3. Intraoperatively, GH levels were estimated to examine acutely the influence of tumour reduction on GH levels. Patients were considered cured when GH levels (GH60min) were less than 2 ng/ml during OGTT 4 weeks after surgery. The data outlined that in patients with normalized GH60min levels, normalized IGFBP-3 levels were noticed 4 weeks and 12 months post-operatively. In non-cured patients normalized IGFBP-3 concentrations were found in 11 out of 15 cases in the late post-treatment phase. In contrast only 1 of 7 cured patients had persistently elevated IGF-I levels within the first month post-operatively, whereas no case of the non-cured patients had IGF-I values in the normal range. Despite these observations a strong correlation of IGF-I and IGFBP-3 did not exist before one year post-operatively -- either in the cured or in the non-cured patients. Serum IGFBP-3 in patients with pituitary acromegaly does not provide a predictive value of appreciable magnitude concerning cure or non-cure from the disease- whether examined early or late in the post-operative period. Absolute levels of IGFBP-3 may thus cause misinterpretation concerning cure of acromegalics after surgery.
口服葡萄糖耐量试验（OGTT）期间的生长激素（GH）浓度和胰岛素样生长因子-I（IGF-I）水平准确反映了肢端肥大症的疾病活动，IGF-I水平代表了GH活性的综合指标。本前瞻性研究旨在评估血浆IGF结合蛋白3（IGFBP-3）是否也能反映垂体性肢端肥大症患者术后早期和晚期随访期间的激素疾病活动。对22例肢端肥大症患者进行了研究。13例患者在术前、术中和术后获取了数据。9例患者仅在治疗后研究肢端肥大症活动。激素评估包括多次采集血样以测定IGF-I、IGFBP-3，并进行多次OGTT。每例患者注射100μg奥曲肽（善宁，山德士公司，巴塞尔）以检测GH、IGF-I和IGFBP-3的急性反应。术中，估计GH水平以急性检查肿瘤切除对GH水平的影响。术后4周OGTT期间GH水平（GH60min）低于2ng/ml时，患者被认为治愈。数据表明，GH60min水平正常的患者，术后4周和12个月时IGFBP-3水平正常。在未治愈的患者中，15例中有11例在治疗后期IGFBP-3浓度正常。相比之下，7例治愈患者中只有1例在术后第一个月内IGF-I水平持续升高，而未治愈患者中没有一例IGF-I值在正常范围内。尽管有这些观察结果，但术后一年内，无论治愈与否，IGF-I和IGFBP-3之间在治愈或未治愈患者中均不存在强相关性。垂体性肢端肥大症患者血清IGFBP-3对于疾病是否治愈没有显著的预测价值——无论是在术后早期还是晚期检查。因此，IGFBP-3的绝对水平可能会导致对肢端肥大症患者术后治愈情况的误解。
