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Héléna Mosbah1, Thierry Brue2, Philippe Chanson1

  • 1Assistance publique-Hôpitaux de Paris, hôpital de Bicêtre, 94275 Le Kremlin-Bicêtre, France; Faculté de médecine Paris-Sud, université Paris-Sud et Université Paris-Saclay, 94276 Le Kremlin-Bicêtre, France.

Annales D'Endocrinologie
|October 14, 2019
PubMed
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Acromegaly, caused by excess growth hormone (GH) and Insulin-Like Growth Factor I (IGF-I), can lead to severe health issues. Monitoring these hormones is key, but discrepancies between GH and IGF-I levels in treated patients require further investigation for better outcomes.

Area of Science:

  • Endocrinology
  • Oncology
  • Radiology

Background:

  • Acromegaly results from excess growth hormone (GH) and Insulin-Like Growth Factor I (IGF-I), often due to pituitary adenomas, causing significant health problems and increased mortality.
  • While transsphenoidal adenomectomy is primary treatment, surgical cure rates are around 50%, necessitating adjuvant therapies.
  • Biochemical control, using GH and IGF-I as biomarkers, has improved mortality, but discordance between these markers occurs in a quarter of treated patients.

Purpose of the Study:

  • To investigate the clinical implications of discordance between GH and IGF-I levels in treated acromegaly patients.
  • To explore persistent symptoms and decreased quality of life despite biochemical control.
  • To evaluate the utility of advanced radiological techniques for assessing bone microarchitecture and fracture risk in acromegaly.
Keywords:
AcromegalyAcromégalieDiscordance GH/IGF-IFractures vertébralesGH/IGF-I discrepancyOsteoarthropathyOstéoarthropathieSpinal fractures

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Main Methods:

  • Review of existing literature on acromegaly treatment and monitoring.
  • Analysis of discordance between GH and IGF-I measurements in treated patients.
  • Exploration of novel radiological methods for bone microarchitecture assessment.

Main Results:

  • Discordance between GH and IGF-I levels is common in treated acromegaly, with unclear impacts on morbidity, mortality, and recurrence.
  • Persistent symptoms and reduced quality of life are observed even with good biochemical control.
  • Bone mineral density is an unreliable fracture risk predictor; advanced imaging may offer better insights into bone microstructural alterations.

Conclusions:

  • Further research is needed to understand the implications of GH/IGF-I discordance in acromegaly.
  • Addressing persistent symptoms and improving bone health assessment are crucial for enhancing patient quality of life.
  • Advanced radiological techniques show promise for better evaluation and prevention of fractures in acromegaly.