ECE2017 Guided Posters Pituitary (12 abstracts)
Targeting either GH or IGF-I levels during somatostatin analogue treatment in patients with acromegaly: A randomized, investigator-initiated multicenter study
Jakob Dal 1 , Marianne Klose 5 , Ansgar Heck 6 , Marianne Andersen 3 , Caroline Kistorp 4 , Eigil Husted Nielsen 2 , Jens Bollerslev 6 , Ulla Feldt-Rasmussen 5 & Jens Otto Lunde Jørgensen 1
1Aarhus University Hospital, Aarhus, Denmark; 2Aalborg University Hospital, Aalborg, Denmark; 3Odense University Hospital, Odense, Denmark; 4Herlev Hospital, Herlev, Denmark; 5National University Hospital, Copenhagen, Denmark; 6Oslo University Hospital and Faculty of Medicine, Oslo, Norway.
Context: Assessment of disease control in acromegaly depends on GH and IGF-I, but discordant values frequently occur. Further, the role of OGTT-suppressed GH (GHnadir) in somatostatin analogue (SA) treated patients is debated.
Objective: To evaluate the effect of targeting either IGF-I or GH during SA treatment.
Design: A randomized, investigator-initiated, multicentre trial.
Patients and methods: 84 patients controlled with either SA (n=61) or surgery-only (n=23) underwent a 3 h GH profile including a 2 h OGTT at baseline, after 6 months (SA treated patients only) and after 12 months together with IGF-I. SA patients were randomized to be monitored by either IGF-I (n=33) or GHnadir (n=28). SA dose increase were allowed at baseline and after 6 months. Symptoms and quality of life (QoL) were assessed by disease-specific questionnaires (PAQ12 and AcroQoL).
Main outcome measures: GH and IGF-I at baseline and 12 months, symptoms and QoL, and SA dose increases.
Results: IGF-I and fasting GH levels at baseline were comparable between the two groups, whereas GHnadir (μg/l) was lower in the surgery group (GHnadir 0.7±0.1 (SA) vs 0.3±0.1 (surgery), P<0.01). At baseline, 31% of SA patients had concordant controlled GH and IGF-I, 43% had elevated GH and 3% elevated IGF-I. Significantly more patients in the surgery group had concordant controlled values (65%), P <0.01. SA dose increase was performed in 20 patients in the GH target group as compared to eight patients in IGF-I target group (P=0.02) and resulted in a higher proportion of controlled patients (P=0.01). SA patients had suppressed insulin levels and elevated glucose and FFA levels during the OGTT compared to surgery. QoL was only mildly affected at baseline and did not change consistently.
Conclusions: i) Discordance between GH and IGF-I is more prevalent during SA treatment as compared to surgery, mainly due to elevated GHnadir levels, ii) targeting discordant GH or IGF-I levels in SA patients translates into SA dose increase and a higher degree of concordance, iii) Our data suggest that a sizable proportion of SA patients are undertreated.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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