期刊
PITUITARY
卷 19, 期 6, 页码 547-551出版社
SPRINGER
DOI: 10.1007/s11102-016-0735-0
关键词
Acromegaly; Pituitary tumor; Insulin-like growth factor 1; Growth hormone
Approximately 25 % of cases of clinically active acromegaly cases treated in our academic center between 1996 and 2000, were diagnosed in patients who had elevated plasma IGF-1 levels, but apparently normal 24-h mean plasma GH levels. The current study served to update the data for patients with acromegaly referred to our facility, after increasing awareness of this normal GH subpopulation throughout the medical community. A retrospective chart review was conducted on 157 patients with acromegaly who underwent resection of a confirmed somatotroph pituitary adenoma at the University of Michigan Health System between the dates of 1 Jan 2001 to 23 Sept 2015. Overall prevalence of acromegalic patients with normal GH levels, defined as GH < 4.7 ng/mL, was 31 %. Over time, the percentage of patients with normal GH at diagnosis did not decline: 26 % from 2001 to 2005, 19 % from 2006 to 2010, and 47 % from 2011 to 2015. Mean pituitary tumor size was 1.8 +/- 0.1 cm for the group with elevated GH, and 1.2 +/- 0.1 cm for the group with normal GH (p < 0.001). Percent microadenomas was higher in a group with normal GH as compared to those with elevated GH (48 vs. 12 %, p < 0.001), and tumors > 2 cm in the maximal diameter were encountered more frequently in the group with elevated GH (43 vs. 14 %, p < 0.001). Our data show that a substantial percentage of patients with clinical acromegaly have normal GH, and therefore strengthens the growing body of evidence which supports the leading role of IGF-1 levels in diagnostic evaluation. At the present time, questions about the natural course of micromegaly and treatment benefits compared to the subpopulation with elevated GH levels remain unanswered, but research continues to build on our understanding of the heterogeneous population of individuals.
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