Caloric restriction as a possible pitfall for persistent acromegaly follow-up - case report

Area of Science:

• Endocrinology
• Metabolic Disorders
• Oncology

Background:

• Acromegaly is diagnosed by elevated Insulin-like Growth Factor 1 (IGF-1) and unsuppressed Growth Hormone (GH) during an Oral Glucose Tolerance Test (OGTT).
• These parameters are crucial for monitoring treatment efficacy in acromegaly patients.

Observation:

• A 29-year-old woman with acromegaly, despite multiple treatments, showed normalized IGF-1 levels while on a severe caloric restriction diet.
• Her IGF-1 levels increased upon resuming an eucaloric diet, indicating the dietary restriction masked disease activity.

Findings:

• Severe caloric restriction can induce GH resistance by decreasing hepatic GH receptor expression, leading to reduced IGF-1 levels.
• This phenomenon can create a false impression of therapeutic success in acromegaly management.

Implications:

• Caloric restriction can be a significant pitfall in acromegaly follow-up, potentially leading to delayed or inadequate treatment adjustments.
• Nutritional status and feeding patterns critically influence the GHRH/GH/IGF-1 axis and must be considered in acromegaly monitoring.