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GH IGF-1 remission

Soraya Puglisi, Federica Spagnolo, Marta Ragonese, Salvatore Cannavò, Francesco Ferraù
The GH-receptor antagonist pegvisomant (PEG) reduces peripheral IGF-1 synthesis and is used to treat acromegaly patients resistant or intolerant to somatostatin analogues (SSA). Medical therapy is generally life-long in patients with acromegaly, since disease remission is very uncommon after SSA discontinuation and has never been reported after PEG withdrawal. Here, we report for the first time the cases of two acromegaly patients treated with PEG monotherapy for many years because of resistance to SSA, who persistently maintained normal serum IGF-1 levels after PEG withdrawal...
February 3, 2019: Growth Hormone & IGF Research
Seyfullah Kan, Muhammed Kizilgul, Bulent Celik, Selvihan Beysel, Mustafa Caliskan, Mahmut Apaydin, Bekir Ucan, Erman Cakal
Nodular thyroid disease is a very common disorder in patients with acromegaly. Insulin-like growth factor-1 (IGF-1) is a thyroid growth factor, and there is a correlation between IGF-1 levels and thyroid volume (TV) in patients with acromegaly. There is no study investigating the impact of somatostatin analog (SSA) treatment on thyroid nodule volume in patients with acromegaly. We aimed to assess thyroid nodule volume change with SSA treatment in patients with persistent acromegaly. We retrospectively analyzed data from 108 consecutive patients with acromegaly who were followed up by our clinic after undergoing surgery between 2002 and 2014...
February 9, 2019: Endocrine Journal
Shih-Chieh Shen, Chiung-Chyi Shen, Ta-Wei Pu, Wen-Yu Cheng
OBJECTIVE: Long-term effects of endoscopic endonasal transsphenoidal intracapsular debulking and adjuvant somatostatin analogs were evaluated in patients with growth hormone secreting pituitary macroadenomas. METHODS: We retrospectively reviewed the medical records of 45 patients with acromegalic macroadenoma who underwent endonasal endoscopic transsphenoidal intracapsular debulking and received adjuvant somatostatin analogs (octreotide) between 2006 and 2015, who had more than 1 year of follow-up...
February 1, 2019: World Neurosurgery
Ming Shen, Yifan Tang, Xuefei Shou, Meng Wang, Qilin Zhang, Nidan Qiao, Zengyi Ma, Zhao Ye, Wenqiang He, Yichao Zhang, Zhengyuan Chen, Zhaoyun Zhang, Hongying Ye, Yiming Li, Shiqi Li, Yao Zhao, Xiang Zhou, Yongfei Wang
BACKGROUND: Factors associated with initial and delayed remission after growth hormone (GH)-secreting pituitary adenoma excision have not been completely elucidated. METHODS: We recruited 185 consecutive patients treated for GH-secreting pituitary adenomas between January 2013 and December 2014 and assessed their tumor characteristics and surgical outcomes. The criteria for initial or delayed remission (based on the 2010 consensus criteria) were normalized insulin-like growth factor 1 (IGF-1) levels, GH levels below 0...
November 27, 2018: World Neurosurgery
F Albarel, F Castinetti, I Morange, N Guibert, T Graillon, H Dufour, T Brue
PURPOSE: To determine whether pre-surgical medical treatment (PSMT) using long-acting Somatostatin analogues in acromegaly may improve long-term surgical outcome and to determine decision making criteria. METHODS: This retrospective study included 110 consecutive patients newly diagnosed with acromegaly, who underwent surgery in a reference center (Marseille, France). The mean long-term follow-up period was 51.4 ± 36.5 (median 39.4) months. Sixty-four patients received PSMT during 3-18 (median 5) months before pituitary surgery...
December 2018: Pituitary
Carla Scaroni, Nora Albiger, Andrea Daniele, Francesca Dassie, Chiara Romualdi, Giovanni Vazza, Daniela Regazzo, Francesco Ferraù, Valeria Barresi, Valeria Maffeis, Marina Paola Gardiman, Salvatore Cannavò, Pietro Maffei, Filippo Ceccato, Marco Losa, Gianluca Occhi
CONTEXT: The oral glucose tolerance test (OGTT) is considered the most useful method for diagnosing active acromegaly and for patient follow-up after neurosurgery. Despite its widespread use, only a few small studies have so far focused on patients' clinical features associated with different GH responsiveness to OGTT. OBJECTIVE: We aimed to investigate the association between glucose-induced GH response and endocrine profiles, clinical manifestations, and response to therapy in a large cohort of patients with acromegaly...
October 3, 2018: Journal of Clinical Endocrinology and Metabolism
Jonathan Rick, Arman Jahangiri, Patrick M Flanigan, Ankush Chandra, Sandeep Kunwar, Lewis Blevins, Manish K Aghi
OBJECTIVEAcromegaly results in disfiguring growth and numerous medical complications. This disease is typically caused by growth hormone (GH)-secreting pituitary adenomas, which are treated first by resection, followed by radiation and/or medical therapy if needed. A subset of acromegalics have dual-staining pituitary adenomas (DSPAs), which stain for GH and prolactin. Presentations and treatment outcomes for acromegalics with DSPAs are not well understood.METHODSThe authors retrospectively reviewed the records of more than 5 years of pituitary adenomas resected at their institution...
September 1, 2018: Journal of Neurosurgery
Ana Laura Espinosa de Los Monteros, Ernesto Sosa-Eroza, Baldomero Gonzalez, Victoria Mendoza, Moises Mercado
Context: The term micromegaly has been used to describe a subset of patients who have elevated IGF-1 levels but apparently normal basal GH (bGH) concentrations and often a glucose-suppressed GH of <1 ng/mL. Objective: To evaluate the prevalence, clinical spectrum, and therapeutic outcome of acromegaly with normal bGH at diagnosis. Design and Methods: Retrospective analysis of a cohort of patients with acromegaly diagnosed and treated at a tertiary care center...
October 1, 2018: Journal of Clinical Endocrinology and Metabolism
Diane Mary Donegan, Nicole Iñiguez-Ariza, Anu Sharma, Todd Nippoldt, William Young, Jamie Van Gompel, John Atkinson, Fredric Meyer, Bruce Pollock, Neena Natt, Nadia Laack, Dana Erickson
OBJECTIVE: Uncontrolled acromegaly is associated with increased morbidity and mortality. Despite multimodal therapeutic options, adequate control can be challenging and lead to prolonged exposure to growth hormone excess. The aim of this study was to assess treatment patterns and outcomes in patients with acromegaly following surgery at a single institution. METHODS: A retrospective analysis of response to treatment modalities for patients with a new diagnosis of acromegaly at the Mayo Clinic in Rochester, Minnesota, from 1995-2015...
July 2018: Endocrine Practice
Hun Ho Park, Eui Hyun Kim, Cheol Ryong Ku, Eun Jig Lee, Sun Ho Kim
BACKGROUND: Cavernous sinus (CS) invasion is an unfavorable factor hindering the remission of growth hormone (GH)-secreting pituitary adenomas. Little data exist on aggressive surgical resection, however. We investigated the role of CS exploration for GH-secreting pituitary adenomas with CS invasion. METHODS: We classified 132 patients with GH-secreting pituitary adenomas invading CS into 4 groups. The patients underwent surgery using a microsurgical transsphenoidal approach (TSA) with endoscopic assistance...
September 2018: World Neurosurgery
Mohammad Taghvaei, Seyed Mousa Sadrehosseini, Javad Behjati Ardakani, Manouchehr Nakhjavani, Mehdi Zeinalizadeh
BACKGROUND: The endoscopic endonasal approach has recently become an acceptable option for resection of all pituitary adenomas. We assessed biochemical outcome of endoscopic endonasal surgery in growth hormone (GH)-secreting adenomas, including remission rate, predictors of remission, and associated complications. METHODS: Sixty-eight consecutive patients with acromegaly who underwent endoscopic endonasal surgery were analyzed prospectively. Tumors were classified according to size, Knosp grade, and Hardy-Wilson classification...
September 2018: World Neurosurgery
Ximene Antunes, Nina Ventura, Gustavo Bittencourt Camilo, Luiz Eduardo Wildemberg, Andre Guasti, Paulo José M Pereira, Aline Helen Silva Camacho, Leila Chimelli, Paulo Niemeyer, Mônica R Gadelha, Leandro Kasuki
BACKGROUND: Transsphenoidal surgery (TSS) is the cornerstone of acromegaly treatment, however there are no robust predictors of surgical outcome and remission can only be defined three months after surgery. PURPOSE: To analyze if biochemical, demographical, radiological, and immunohistochemical characteristics are predictors of surgical remission and investigate if immediate postoperative GH and IGF-I levels can help defining remission earlier. METHODS: Consecutive acromegaly patients submitted to TSS between 2013-2016 were evaluated...
June 2018: Endocrine
Baldomero González, Guadalupe Vargas, Ana Laura Espinosa de Los Monteros, Victoria Mendoza, Moisés Mercado
Context: Diabetes and hypertension are frequent comorbidities of acromegaly. Objective: To analyze the course of diabetes and hypertension at diagnosis and after multimodal therapy in a large cohort of patients with acromegaly. Design and Setting: Retrospective study at a tertiary care center. Patients and Methods: A total of 522 patients with acromegaly treated according to a preestablished protocol. Main Outcome Measures: Prevalence of diabetes and hypertension and its relationship with biochemical indices of acromegalic control...
June 1, 2018: Journal of Clinical Endocrinology and Metabolism
Elena Roca, Pier Paolo Mattogno, Teresa Porcelli, Luigi Poliani, Francesco Belotti, Alberto Schreiber, Filippo Maffezzoni, Marco Maria Fontanella, Francesco Doglietto
BACKGROUND: Plurihormonal adenomas (PHAs) represent 10%-15% of all functioning pituitary adenomas. The most frequent hormonal associations are with prolactin and growth hormone (GH). Here we describe a rare case of functional adrenocorticotropic hormone (ACTH) and GH microadenoma and report our findings from a systematic literature review of PHA. METHODS: We searched PubMed using the terms "plurihormonal pituitary adenoma," "ACTH GH pituitary adenoma," and "acromegaly AND Cushing's disease"...
June 2018: World Neurosurgery
Zhaoyun Zhang, Qin Li, Wenqiang He, Huijia Qiu, Hongying Ye, Yongfei Wang, Ming Shen, Min He, Yifei Yu, Xuefei Shou, Chuanxin Huang, Huan Yu, Guoqian Huang, Weijun Tang, Daoying Geng, Chaowei Fu, Congjin Liu, Zengyi Ma, Zhao Ye, Qilin Zhang, Yichao Zhang, Yue Shen, Yeping Yang, Meng Wang, Xingdang Liu, Yun Lu, Renming Hu, Ying Mao, Liangfu Zhou, Yiming Li, Shiqi Li, Nicholas A Tritos, Yao Zhao
CONTEXT: Chronic excess of growth hormone (GH) often leads to systemic complications. The reversibility of these complications after GH resolution is not fully understood. OBJECTIVE: To investigate when and to what extent will the comorbidities be ameliorated. DESIGN: We conducted a prospective study comprising 24 patients with acromegaly, who achieved remission after transsphenoidal surgery. The dynamic changes of endocrine, cardiovascular, respiratory, sleep, bone and morphology parameters were evaluated at enrollment and 1 week, 1 month, 3 months, 6 months and 12 months after surgery...
April 2018: European Journal of Endocrinology
Shinjan Patra, Sugata Narayan Biswas, Joydip Datta, Partha Pratim Chakraborty
A young man with subtle clinical features suggestive of hypersomatotropism presented with acute-onset severe headache. Relevant investigations confirmed polycythaemia and growth hormone (GH)-secreting pituitary macroadenoma with apoplexy. Secondary polycythaemia and myeloproliferative disorders were ruled out. At follow-up after 3 months, resolution of polycythaemia and acromegaly was observed, evident on normal haemoglobin levels, a normocellular marrow, and normal insulin-like growth factor-1 (IGF-1) with glucose-suppressed GH levels...
December 7, 2017: BMJ Case Reports
Lian Duan, Huijuan Zhu, Bing Xing, Feng Gu
BACKGROUND: This study aimed to investigate preoperative somatostatin analogs (SSAs) treatment on the surgical outcome in patients with acromegaly. METHODS: An analysis of 358 patients with acromegaly was conducted. The preoperative medical therapy group (81 patients) received SSA treatment for at least 3 months prior to surgery, while the primary surgery group (277 patients) underwent transsphenoidal surgery directly. Follow-up duration was ≥3 months. Tumor invasion was evaluated by magnetic resonance imaging (MRI) and classified according to the Knosp grading system...
September 6, 2017: BMC Endocrine Disorders
Caroline Martins Dos Santos Leopoldo, Felippe Martins Dos Santos Leopoldo, Américo Rubens Leite Dos Santos, José Carlos Esteves Veiga, José Viana Lima, Nilza Maria Scalissi, Paulo Roberto Lazarini, Ricardo Landini Lutaif Dolci
Objective: The aim of this study was to evaluate the results of the endoscopic transsphenoidal technique for growth hormone (GH)-secreting adenomas. Methods: A retrospective analysis based on medical records of 23 acromegalic patients submitted to endoscopic transsphenoidal surgery. Biochemical control was defined as basal GH < 1ng/ml, nadir GH < 0.4ng/ml after glucose load and age-adjusted IGF-1 normal at the last follow-up. Results: The overall endocrinological remission rate was 39...
May 2017: Arquivos de Neuro-psiquiatria
Cecilia Fernández Mateos, Maria García-Uria, Tomás Lucas Morante, José García-Uría
PURPOSE: The goal of this study was to quantified the results of microsurgery, in all the patients with acromegaly treated by the same endocrinologist and the same surgeon between 1975 and 2015. METHODS: A series of 548 patients with acromegaly were operated and followed-up from 6 months to 40 years. Patients were selected according to five criteria: (1) Operated by the same surgeon. (2) No previous treatment. (3) Complete endocrinological preoperative studies including GH, OGTT, IGF-I, PRL test and TC/MRI...
October 2017: Pituitary
G Y Yalin, S Tanrikulu, N Gul, A K Uzum, F Aral, R Tanakol
PURPOSE: High GH and IGF I levels increase tubular phosphate reabsorption in patients with acromegaly. We aimed to investigate the utility of serum phosphorus levels as an indicator for predicting chance of remission in acromegaly patients. DESIGN: Fifty-one patients (n: 51; F: 24, M: 27) with diagnosis of acromegaly were included in the study. Plasma IGF-1, Phosphorus (P) and nadir GH levels on oral glucose tolerance test (OGTT) at the time of diagnosis were analysed retrospectively...
August 2017: Journal of Endocrinological Investigation
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