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- Title
Postoperative persistent thyrotrophin releasing hormone-induced growth hormone release predicts recurrence in patients with acromegaly.
- Authors
Biermasz, Nienke R; Smit, Jan W. A; van Dulken, Hans; Roelfsema, Ferdinand
- Abstract
Summary objective To assess the predictive value of postoperative thyrotrophin releasing hormone (TRH)-induced GH responsiveness in relation to (late) postoperative outcome in patients in remission after surgery for acromegaly. patients and methods One hundred and twenty-nine patients underwent surgery for acromegaly in our institution between 1977 and 1996. TRH tests and oral glucose tolerance tests (GTT) were performed and serum IGF-I concentrations were measured pre- and postoperatively and during follow-up. Criteria for postoperative remission were a mean serum GH concentration < 5 mU/l and/or serum GH after an oral glucose tolerance test < 1 mU/l immunofluorometric assay (IFMA) or < 2·5 mU/l (radioimmunosassay), together with a normal serum IGF-I concentration. results Preoperatively, the TRH-induced GH response was highly variable, with gradual overlap between ‘nonresponders’ and ‘responders’. Arbitrarily defined as a doubling of serum GH concentration, 45·6% of patients were ‘responders’ to TRH. GH response after TRH injection was significantly correlated to the TRH-induced prolactin response but not to preoperative GH concentration or adenoma size. After surgery, remission was achieved in 83 of the 129 patients. Postoperative remission was significantly correlated to mean preoperative serum GH concentration and preoperative glucose-suppressed serum GH but not to tumour class. Seventy-one patients with early postoperative remission were followed without adjuvant treatment for a mean of 9·4 ± 0·7 years (range 0–23 years). Forty-one of these patients were TRH responsive as defined by at least doubling of the serum GH concentration preoperatively. Of the 71 patients, 12 developed recurrence of disease, as defined by insufficient GH suppression during oral GTT, and elevated IGF-I and mean serum GH concentration. Irrespective of the preoperative response to TRH, the initial postoperative...
- Subjects
THYROTROPIN; ACROMEGALY
- Publication
Clinical Endocrinology, 2002, Vol 56, Issue 3, p313
- ISSN
0300-0664
- Publication type
Article
- DOI
10.1046/j.1365-2265.2002.01465.x