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Revisiting the Role of Insulin-like Growth Factor-1 Measurement After Surgical Treatment of Acromegaly

 In-Ho Jung  ;  Seonah Choi  ;  Cheol Ryong Ku  ;  Sang-Guk Lee  ;  Eun Jig Lee  ;  Sun Ho Kim  ;  Eui Hyun Kim 
 JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM, Vol.106(7) : e2589-e2599, 2021-06 
Journal Title
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Acromegaly ; growth hormone ; insulin-like growth factor-1 ; pituitary adenoma ; remission ; transsphenoidal surgery
Context: In the management of growth hormone (GH)-secreting pituitary adenomas, the oral glucose tolerance test (OGTT) has been the gold standard not only for diagnoses but also for the determination of biochemical remission. Insulin-like growth factor-1 (IGF-1) is an essential biomarker, although it should be adjusted for both age and sex.

Objective: We evaluated whether IGF-1 levels could serve as a reliable alternative to an OGTT for disease monitoring after the surgical treatment of acromegaly. We retrospectively reviewed the medical records of 320 patients who underwent surgical resection of their GH-secreting pituitary tumors at the Severance hospital. Receiver operator characteristic (ROC) analyses were performed to validate the accuracy of IGF-1 levels for the assessment of remission. In addition, regression analyses were performed to identify factors associated with discrepancy between OGTT and IGF-1 levels.

Results: Except for 1 week after surgery, ROC analyses showed an area under the curve of greater than 0.8 for IGF-1 at all time points. Of 320 patients, 270 achieved endocrine remission after surgery alone. Among these patients, IGF-1 levels were normalized in 250 patients. The mean duration from surgery to IGF-1 normalization was 4.7 months. Regression analyses demonstrated that risk of failed IGF-1 normalization was increased by 3.1-fold when the tumor invaded the cavernous sinus and increased by 9.0-fold in patients with incomplete tumor removal.

Conclusion: IGF-1 level is a reliable alternative to OGTT and plays a valuable role in monitoring acromegaly status.
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Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Laboratory Medicine (진단검사의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Neurosurgery (신경외과학교실) > 1. Journal Papers
Yonsei Authors
Ku, Cheol Ryong(구철룡) ORCID logo https://orcid.org/0000-0001-8693-9630
Kim, Sun Ho(김선호) ORCID logo https://orcid.org/0000-0003-0970-3848
Kim, Eui Hyun(김의현) ORCID logo https://orcid.org/0000-0002-2523-7122
Lee, Sang-Guk(이상국) ORCID logo https://orcid.org/0000-0003-3862-3660
Lee, Eun Jig(이은직) ORCID logo https://orcid.org/0000-0002-9876-8370
Jung, In-Ho(정인호)
Choi, Seonah(최선아)
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