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A. Pollak, A. Lischka, W. Bartl, M. Langer, F. Waldhauser, S. Levin, R. Schmid and R. Gherardini

Abstract. Glycated plasmaproteins (GPP) and glycated hemoglobin (G Hb) has been evaluated in 134 non-diabetics (ND), 299 women with potential abnormality of glucose tolerance (pot.AGT), 75 with impaired glucose tolerance (IGT) and 34 insulin dependent diabetics (IDDM) during pregnancy or postpartum including 94 cord blood determinations. Mean HbAIC levels were significantly elevated in IDDM (6.6 ± 1.3% m ± sd) compared to ND (5.1 ± 0.7%; P < 0.01), but were similar for the other groups studied. Mean GPP were increased for the IDDM (0.58 ± 0.29 nmol 5–HMF/mg protein; m ± sd) and the IGT-group (0.53 ± 0.22) over ND (0.3 ± 0.13; P < 0.01) and the Pot.AGT group (0.37 ± 0.14; P < 0.01). 6% of the ND, 15% of the Pot AGT-, 52% of the IGT- and 62% of the IDDM group were found to have GPP values exceeding the 97% confidential limit of the ND. However, the large overlap of individual values from patients with different degrees of glucose intolerance with the normal range of pregnancy precludes the use of GPP as a screening parameter for IGT during pregnancy. A 30–35% reduction of fetal hemoglobin- and plasma protein glycation relative to maternal values was observed.

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U J Knappe, D Petroff, M Quinkler, S M Schmid, C Schöfl, J Schopohl, M R Stieg, A Tönjes and the participants of the German Acromegaly Registry

Background

If biochemical control of acromegaly is not achieved by operation and medication, radiotherapy may be indicated.

Objective

To describe fractionated radiotherapy (FRT) and stereotactic radiosurgery (SRS) regarding excess of IGF-1 and pituitary function.

Design and methods

A retrospective analysis of 352 patients (4126 patient-years) from the German Acromegaly Registry was performed. Follow-up was 1.0–45.1 years after radiotherapy. Therapeutic success was defined by low or normal IGF-1 according to center-specific reference ranges without (= remission) or on (= controlled disease) suppressive medication.

Results

Time between radiotherapy and last follow-up was 13.0 ± 8.2 years for FRT (n = 233) and 8.9 ± 5.0 years for SRS (n = 119, P < 0.001). Median (IQR) basal growth hormone before radiotherapy was 6.3 (2.9–16.2) ng/mL for FRT and 3.5 (1.8–6.9) ng/mL for SRS (P < 0.001). Mean time in uncontrolled state was 3.0 years after FRT and 2.1 years after SRS (95% CI for the difference is 0.1 to 1.6 years, P = 0.021). The 10-year calculated remission rate was 48% for FRT and 52% for SRS (95% CI for the difference is −18 to 26% age points, P = 0.74) and the respective controlled disease rate was 23 and 26%. The odds ratio for adrenocorticotropic or thyreotropic insufficiency was 0.54 (95% CI: 0.30–1.00, P = 0.049) in SRS compared to FRT patients.

Conclusion

Both after FRT and SRS about 75% of patients with acromegaly are in remission or controlled after 10 years. A slightly faster achievement of target values was observed after SRS. The rate of pituitary insufficiency in FRT patients is significantly higher.