Endocrine Abstracts

GH is not just a hormone that increases IGF-I concentrations. GH, IGF-I and insulin sometimes antagonize or amplify each other’s direct actions. In this interplay, for translating GH actions into IGF-I production, the production of endogenous insulin that reaches the liver via the portal vein is an essential factor. In fact, insulin decides whether GH is allowed to generate IGF-I production and release by the liver. By not considering GH, IGF-1 and insulin altogether, clinicians will not be able to assess and understand the complex changes in metabolism in which GH, IGF-I and insulin play a major role. Therefore, in case of diabetes (both type 1 and 2), in acromegaly and in liver failure, a thorough understanding of normal- and pathophysiology will certainly help the treating physician to make the right decisions on how to intervene and improve metabolism for the benefit of the patient. One of the pitfalls that endocrinologists and other clinicians frequently encounter is that they focus on the known signs and symptoms of diseases when asking about the complaints of their patients. Acromegaly patients e.g. are asked about their headaches, perspiration, oedema, and fatigue. Other complaints are easily ignored as they are considered not to be part of the classical list of signs and symptoms of acromegaly. Equally so, we also trust too much on the laboratory results and in fact, we too often tell our acromegaly patients that they should be fine when we have normalized their serum IGF-I levels. When we carefully start to listen to our patients, we must conclude that they should tell us whether they feel great or not and not the other way around.