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Hypothalamic dysfunction in "cured" acromegaly is treatment modality dependent

S R Peacey1, A A Toogood, S M Shalet

  • 1Department of Endocrinology, Christie Hospital, Manchester, United Kingdom.

The Journal of Clinical Endocrinology and Metabolism
|May 20, 1998
PubMed
Summary
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With commentary.

Archives of disease in childhood·2010

Acromegaly cure definition is GH < 2 ng/mL. Radiotherapy, unlike surgery, significantly reduces growth hormone (GH) response to arginine, suggesting loss of somatostatin tone in cured acromegaly patients.

Area of Science:

  • Endocrinology
  • Neuroendocrinology

Background:

  • Acromegaly is characterized by excess growth hormone (GH) and IGF-1.
  • Current cure definition for acromegaly is a GH level below 2 ng/mL.
  • Therapeutic modalities like surgery and radiotherapy may differentially impact hypothalamic control of GH secretion.

Purpose of the Study:

  • To investigate the effect of therapy modality (surgery vs. radiotherapy) on hypothalamic-somatotroph function in cured acromegaly patients.
  • To assess endogenous somatostatin (SMS) tone using the GH response to arginine as a paradigm.

Main Methods:

  • Studied 20 patients with cured acromegaly (GH < 2 ng/mL) divided into surgery (S) and radiotherapy (R) groups.
  • Included 16 healthy subjects as a control group (C).
  • Administered intravenous arginine to assess GH response and compared responses between groups.

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Main Results:

  • Median 24-h GH levels were similar across surgery, radiotherapy, and control groups.
  • Median incremental GH response to arginine was significantly lower in the radiotherapy group compared to surgery and control groups (P = 0.0002).
  • Radiotherapy cure was associated with a marked reduction or loss of endogenous somatostatin tone.

Conclusions:

  • Therapy modality significantly influences residual hypothalamic-somatotroph function in cured acromegaly.
  • Radiotherapy appears to diminish or abolish endogenous somatostatin tone, impacting GH regulation.
  • Findings may inform treatment strategies for acromegaly patients not achieving cure with current therapies.