Monday, November 1, 2010

GH Response to Oral Glucose Tolerance Test: A Comparison between Patients with Acromegaly and Other Pituitary Disorders.

Verrua E, Filopanti M, Ronchi CL, Olgiati L, Ferrante E, Giavoli C, Sala E, Mantovani G, Arosio M, Beck-Peccoz P, Lania AG, Spada A

Department of Medical Sciences (E.V., M.F., C.L.R., L.O., E.F., C.G., E.S., G.M., M.A., P.B.-P., A.G.L., A.S.), University of Milan, and Unit of Endocrinology and Diabetology (E.V., M.F., C.L.R., L.O., E.F., C.G., E.S., G.M., P.B.-P., A.G.L., A.S.), Fondazione Instituto di Ricovero e Cura a Carattere Scientifico Ca' Granda, 20122 Milan, Italy; and Unit of Endocrine Diseases (M.A.), Ospedale S. Giuseppe Multimedica, 20123 Milan, Italy.

J Clin Endocrinol Metab 2010 Oct 20.

Context: The cutoff value of nadir GH after an oral glucose tolerance test (OGTT) used to define disease remission in acromegaly is higher than that observed in healthy subjects. However, it is uncertain whether the impaired GH inhibition might be related to subtle abnormalities of GH secretion or to functional and/or anatomical hypothalamic-pituitary disconnection due to tumor per se or treatments.

Objective: The objective of the study was to evaluate the impact of pituitary disorders other than acromegaly on GH response to OGTT.


Design, Subjects, and Methods: Thirty-three patients (24 females and nine males, aged 50.1 ± 12.3 yr, 13 operated and two irradiated) with various hypothalamic-pituitary disorders (HPDs), 45 healthy subjects (controls), and 42 cured acromegalic patients matched for sex, age. and body mass index were investigated. All subjects were studied for IGF-I levels and GH levels before and during the OGTT.

Results: In HPD patients mean postglucose nadir GH levels were 0.11 ± 0.08 μg/liter without any difference between patients treated with neurosurgery and/or radiotherapy and untreated and between patients with and without pituitary stalk alterations and/or hyperprolactinemia. Mean nadir GH values were similar in HPD patients and controls (0.11 ± 0.08 vs. 0.08 ± 0.08 μg/liter, P = 0.23) and lower than those found in cured acromegalic patients (0.18 ± 0.13 μg/liter, P = 0.02), although there was an overlapping in about half of patients.

Conclusions: Hypothalamic control of glucose-mediated GH suppression is not perturbed in patients with HPD. These data indicate that defective GH suppression to glucose that is found in acromegaly is unlikely to reflect a lack of integrity of hypothalamic function.


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