Associations of coefficient of variation of serum GH with previous radiotherapy, hypopituitarism and cardiac disease in patients with treated acromegaly

作者：Jayasena Channa N; Izzi Engbeaya Chioma; Narayanaswamy Shakunthala; Modi Manish; Clarke Holly; Nijher Gurjinder M K; Meeran Karim; Dhillo Waljit S^*

来源：Clinical Endocrinology, 2015, 82(6): 870-875.

DOI：10.1111/cen.12685

BackgroundCardiovascular complications represent the biggest cause of mortality in acromegaly. It is therefore important to optimally stratify acromegalic patients according to disease activity and complication risk. GH is secreted in a pulsatile manner from the pituitary gland, but GH pulsatility is not routinely assessed clinically. The coefficient of variation of serum GH (GHCV) during oral glucose tolerance test (OGTT) quantifies the variation of GH secretion in patients with acromegaly, but has not been reported previously.
AimTo investigate whether GHCV during OGTT is associated with clinical parameters predicted to relate with hypothalamo-pituitary dysfunction during acromegaly, such as radiotherapy treatment, pituitary deficiency and cardiac disease.
MethodsGHCV was calculated during 584 OGTTs and compared with nadir serum GH and IGF-1 in 111 acromegalic patients treated at a single centre.
ResultsAcromegalic patients treated with radiotherapy had a 37% lower level of GHCV when compared to the nonradiotherapy group (mean GHCV: 02980015, no radiotherapy; 0189 +/- 0007, radiotherapy; P<0001). Neither serum IGF-1 nor nadir GH was significantly altered in the radiotherapy group. Mean GHCV was 50% lower in the acromegalic patients with cardiac failure when compared to acromegalic patients with normal echocardiogram (0161 +/- 0034 vs 0297 +/- 0055; P<005). Neither serum IGF-1 nor nadir GH was significantly altered during cardiac failure.
ConclusionOur preliminary data suggest that GHCV during OGTT may be reduced during acromegaly in patients with previous radiotherapy, pituitary deficiencies and cardiac disease. Larger studies are required to determine whether GHCV could provide help to assess the morbidity status of patients with treated acromegaly.

• 出版日期2015-6