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Targeting either GH or IGF-I during somatostatin analogue treatment in patients with acromegaly: a randomized
Jakob Dal1,2, Marianne Klose3, Ansgar Heck4
1Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark.
Context:
Discordant GH and IGF-I values are frequent in acromegaly. The clinical significance and its dependence on treatment modality and of glucose-suppressed GH (GHnadir) measurements remain uncertain.
Objective:
To evaluate the effects of targeting either IGF-I or GH during somatostatin analogue (SA) treatment.
Patients And Methods:
84 patients with controlled acromegaly after surgery (n = 23) or SA (n = 61) underwent a GH profile including an OGTT, at baseline and after 12 months. SA patients were randomized to monitoring according to either IGF-I (n = 33) or GHnadir (n = 28). SA dose escalation was allowed at baseline and 6 months.
Main Outcome Measures:
GHnadir and IGF-I at baseline and 12 months, and disease-specific Quality of Life (QoL).
Results:
IGF-I and fasting GH levels were comparable between the surgery and the SA group, whereas GHnadir (µg/L) was lower in the surgery group (GHnadir 0.7 ± 0.1 vs 0.3 ± 0.1, P < 0.01). SA dose increase was performed in 20 patients in the GH group and in 8 patients in the IGF-I group (P = 0.02), which increased the number of concordantly controlled patients (P = 0.01). QoL was only mildly affected at baseline in all groups and did not changed consistently during the study.
Conclusion:
(1) Discordant values in terms of high GH levels are prevalent in SA patients and more so if applying glucose-suppressed GHnadir; (2) targeting discordant levels of either GH or IGF-I translates into SA dose increase and improved biochemical control; (3) even though QoL was not improved in this study, we suggest biochemical assessment of disease activity to include glucose-suppressed GHnadir also in SA patients.
Insights
Discordant growth hormone (GH) and IGF-I levels are common in acromegaly. Targeting glucose-suppressed GH (GHnadir) in somatostatin analogue (SA) treatment improves biochemical control.
Area of Science:
- Endocrinology
- Metabolic Disorders
- Oncology
Background:
- Discordant growth hormone (GH) and insulin-like growth factor I (IGF-I) levels are frequently observed in acromegaly patients.
- The clinical significance of these discordant values, particularly concerning treatment modality and glucose-suppressed GH (GHnadir) measurements, remains unclear.
Purpose of the Study:
- To investigate the impact of targeting either IGF-I or GHnadir during somatostatin analogue (SA) therapy in acromegaly.
- To assess the effectiveness of different monitoring strategies on biochemical control and treatment adjustments.
Main Methods:
- Eighty-four acromegaly patients, post-surgery or on SA treatment, underwent GH profiling with OGTT at baseline and 12 months.
- SA-treated patients were randomized to IGF-I or GHnadir monitoring, with SA dose escalation permitted.
Main Results:
- While IGF-I and fasting GH were similar between groups, GHnadir was lower in post-surgery patients.
- Targeting GHnadir led to more frequent SA dose increases and improved concordant biochemical control compared to targeting IGF-I.
- Quality of Life (QoL) showed minimal baseline changes and no consistent improvement during the study.
Conclusions:
- Discordant GH levels, especially GHnadir, are prevalent in SA-treated acromegaly patients.
- Adjusting SA therapy based on discordant GH or IGF-I levels improves biochemical control.
- Glucose-suppressed GHnadir should be considered in the biochemical assessment of acromegaly activity in SA-treated patients.