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Prognostic value of nadir GH levels for long-term biochemical remission or recurrence in surgically treated acromegaly

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Abstract

Context

Outcome of acromegaly surgery is assessed by IGF-1 and glucose-suppressed GH, but whether the latter provides additional clinically relevant information when IGF-1 is normal is unclear. The role of GH suppression testing after surgery requires clarification.

Methods

We studied 97 acromegaly patients with normal IGF-1 after surgery by measuring GH after oral glucose longitudinally, initially at ≥ 3 months after surgery and repeated one or more times ≥ 1 year later. Nadir GH was categorized as normal or abnormal relative to the 97.5th percentile of nadir GH in 100 healthy subjects, which were ≤ 0.14 µg/L (DSL IRMA) or ≤ 0.15 µg/L(IDS iSYS). Signs and symptoms scores and insulin resistance were followed longitudinally.

Results

Of 68 patients with initial normal GH suppression 63 (93%) remained in remission and of 29 with initial abnormal GH suppression, 9 (31%) recurred. Recurrence was more common in patients with abnormal suppression (P < 0.001). A total of 14 patients recurred, including 5 with normal GH suppression progressing to abnormal and then recurrence. Overall, serial signs and symptoms and insulin resistance assessments did not identify patients with abnormal suppression or recurrence.

Conclusion

Risk of recurrence after surgery is increased for patients with a normal IGF-1 level, but abnormal GH suppression. We newly find, using both our and others’ cut-offs, that while normal suppression predicts long-term remission in most patients, some can progress from normal to abnormal suppression and then recurrence after many years of follow up. Nadir GH levels are of prognostic value in acromegaly patients with normal IGF-1 levels after surgery.

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Funding

Funded by NIH Grants R01 DK 110771 and DK064720 to PUF, and in part by Columbia University’s CTSA Grant No. UL1 TR000040 from NCATS/NIH.

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Authors and Affiliations

  1. Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, 650 West 168th Street, Rm.1014, New York, NY, 10032, USA

    Pamela U. Freda, Carlos Reyes-Vidal & Simran Singh

  2. Department of Neurosurgery, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA

    Jeffrey N. Bruce

  3. Department of Radiology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA

    Alexander G. Khandji

  4. Department of Pathology and Cell Biology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA

    Yessica DeLeon & Serge Cremers

  5. Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA

    Zhezhen Jin

  6. Department of Neurosurgery, Mount Sinai School of Medicine, New York, NY, USA

    Kalmon D. Post

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  1. Pamela U. Freda
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  2. Jeffrey N. Bruce
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  3. Carlos Reyes-Vidal
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  4. Simran Singh
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  5. Yessica DeLeon
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  7. Alexander G. Khandji
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  9. Kalmon D. Post
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Correspondence to Pamela U. Freda.

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PUF, JNB, CRV, SS, JD, ZJ, AGK, SC and KDP have nothing to disclose.

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Freda, P.U., Bruce, J.N., Reyes-Vidal, C. et al. Prognostic value of nadir GH levels for long-term biochemical remission or recurrence in surgically treated acromegaly. Pituitary 24, 170–183 (2021). https://doi.org/10.1007/s11102-020-01094-4

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