Discordant GH and IGF-1 levels in acromegaly: Analysis of clinical characteristics and impact of GH cut-offs on discordance rate
10.3760/cma.j.cn311282-20240308-00089
- VernacularTitle:GH/IGF-1不一致的肢端肥大症患者临床特征分析及GH不同切点对不一致率的影响
- Author:
Liye CHONG
1
;
Mengsi LIU
;
Ziwei ZHANG
;
Fan YANG
;
Dalong ZHU
;
Ping LI
Author Information
1. 南京大学医学院附属鼓楼医院内分泌科，南京 210008
- Keywords:
Acromegaly;
Discordant GH and IGF-1;
GH cut-offs;
Glucose metabolism;
Bone metabolism
- From:
Chinese Journal of Endocrinology and Metabolism
2024;40(11):941-947
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To analyze clinical characteristics of acromegaly patients who have discordant growth hormone(GH) or insulin-like growth factor-1(IGF-1) levels and evaluate impact of different GH cut-offs on discordance rate.Methods:A retrospective analysis was conducted on data from 66 acromegaly patients treated at Nanjing Drum Tower Hospital from November 2017 to March 2023. Patients were categorized based on the nadir GH(GHn) and IGF-1 levels at the last follow-up into four groups: controlled, high GH, high IGF-1, and active. Clinical and metabolic parameters were compared across these groups, and impact of different GHn and fasting growth hormone(GHf) cut-offs on discordance rate was evaluated.Results:No statistically significant differences were observed among groups in age, duration of follow-up, imaging characteristics(all P>0.05). High IGF-1 group had higher fasting insulin and homeostasis model assessment for β cell function compared to controlled and high GH group(all P<0.05), while these parameters did not differ between high GH and controlled group. High IGF-1 group had higher carboxy-terminal cross-linked telopeptide of type 1 collagen, osteocalcin and procollagen type 1 N-terminal propeptide compared to controlled and high GH group, but differences were not statistically significant(all P>0.05). These parameters also did not differ between high GH and controlled group. Discordance rate was not significantly different when GHn cut-offs was 1.0 μg/L or 0.4 μg/L(30.3% vs 21.3%, P=0.146). Compared to 2.5 μg/L, discordance rate was lower when GHf cut-off was 1.0 μg/L(39.4% vs 24.3%, P=0.041). Conclusion:The discordance rate in treated acromegaly patients during follow-up is approximately 30%. Different GH measurement timings and cut-offs significantly impact discordance rate. Patients with normal GH and elevated IGF-1 levels are at potential risk of active disease, and require closer follow-up. This study provides a valuable reference for treatment of patients with discordant GH and IGF-1 levels.
