Revisiting growth hormone nadir cut-offs for remission in patients with acromegaly

in European Journal of Endocrinology
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  • 1 Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
  • | 2 Endocrinology, Institute of Endocrine Research, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
  • | 3 Pituitary Tumor Center, Severance Hospital, Seoul, Republic of Korea
  • | 4 Yonsei University Graduate School of Medicine, Seoul, Republic of Korea
  • | 5 Department of Radiology, Yonsei University College of Medicine, Seoul, Republic of Korea
  • | 6 Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Republic of Korea
  • | 7 Department of Internal Medicine, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Republic of Korea

Correspondence should be addressed to C R Ku; Email: cr079@yuhs.ac
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Objective

Over the past decade, the growth hormone (GH) nadir cut-off during the oral glucose tolerance test for remission in patients with acromegaly was changed from 0.4 to 1.0 μg/L due to the limited use of ultrasensitive detection kits to measure GH levels. However, the optimal cut-off level for GH nadir remains unclear. This retrospective study aimed to investigate the association between different GH nadir cut-offs and prognosis in patients with acromegaly.

Design and methods

A total of 285 patients with acromegaly with a glucose-suppressed GH nadir <1 μg/L at 3–6 months after trans-sphenoidal adenomectomy were divided into two groups according to the glucose-suppressed GH nadir levels at 3–6 months post-operatively (group A: <0.4 μg/L; group B: 0.4–1.0 μg/L). GH levels were measured using an ultrasensitive IRMA. The clinical, hormonal, metabolic, and neuroradiological data of the two groups were compared.

Results

Female sex, as well as confirmed macroadenomas, was significantly overrepresented in group B. The 5-year rate of patients who achieved nadir GH < 1.0 μg/L and age- and sex-matched normal IGF-1 was significantly higher in group A than that in group B. However, there was no significant difference between the two groups in metabolic parameters at 12 months post-operatively.

Conclusion

Different GH nadir cut-offs were associated with different 5-year rates of patients who achieved nadir GH <1.0 μg/L and age- and sex-matched normal IGF-1, suggesting that a strict GH nadir threshold of 0.4 μg/L correlates better with remission.

 

     European Society of Endocrinology

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