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Early postoperative prediction of both disease remission and long-term disease control in acromegaly using the oral glucose tolerance test

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Abstract

Purpose

Transsphenoidal surgery (TSS) is the cornerstone of acromegaly treatment. Two biochemical parameters, growth hormone (GH) and insulin-like growth factor-1 (IGF-1) levels, sometimes diverge postoperatively; however, it is important to maintain disease control without further treatment, regardless of whether these parameters converge. This study investigated whether remission and long-term disease control could be predicted using early postoperative GH and IGF-1 levels.

Methods

We reviewed 36 consecutive surgically treated patients with acromegaly. IGF-1 levels and minimum GH levels during an oral glucose tolerance test (OGTT) were evaluated at 2 weeks, as well as at 3 months postoperatively. After comparison between the remission and nonremission groups, we analyzed whether early postoperative parameters could predict remission and long-term disease control.

Results

Twenty-five patients (69.4%, Group A) achieved remission within 1 year postoperatively. Of the remaining patients (median follow-up period, 53 months), seven (19.5%, Group B) maintained normal IGF-1 levels without treatment, whereas four (11.1%, Group C) required additional treatment. GH levels <1.5 ng/mL measured on the morning after surgery and nadir GH levels <0.7 ng/mL during the OGTT conducted at 2 weeks postoperatively were predictive of remission, with the latter demonstrating 95.2% sensitivity and 100% specificity. All group C patients had nadir GH levels ≥0.7 ng/mL during the OGTT and IGF-1 levels ≥SD +3 at 2 weeks postoperatively.

Conclusion

Early postoperative nadir GH levels during the OGTT and IGF-1 levels at 2 weeks postoperatively demonstrated excellent predictive value for both endocrinological remission and the necessity for additional treatment.

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Data availability

The datasets and analyzed data in this current study are available from the corresponding author upon reasonable request.

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Acknowledgements

We would like to thank our helpful and efficient nursing, ENT, and anesthesiology teams for perioperative management of the endoscopic endonasal pituitary surgery.

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Authors and Affiliations

  1. Department of Neurosurgery, Kurume University School of Medicine, Fukuoka, Japan

    Kiyohiko Sakata, Yui Nagata, Nobuyuki Takeshige, Jin Kikuchi & Motohiro Morioka

  2. Division of Endocrinology and Metabolism, Department of Internal Medicine, Kurume University School of Medicine, Fukuoka, Japan

    Masato Shikata, Kenji Ashida & Masatoshi Nomura

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  1. Kiyohiko Sakata
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  2. Yui Nagata
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  3. Nobuyuki Takeshige
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  6. Kenji Ashida
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  7. Masatoshi Nomura
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  8. Motohiro Morioka
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Contributions

Conceptualization: Kiyohiko Sakata and Nobuyuki Takeshige.

Methodology: Kiyohiko Sakata, Yui Nagata, Nobuyuki Takeshige, and Kenji Ashida.

Formal analysis and investigation: Kiyohiko Sakata, Yui Nagata, and Masato Shikata.

Writing—original draft preparation: Kiyohiko Sakata.

Writing—review and editing: Motohiro Morioka

Funding acquisition: Kiyohiko Sakata and Motohiro Morioka.

Resources: Jin Kikuchi and Masato Shikata.

Supervision: Kenji Ashida and Masahito Nomura.

Corresponding author

Correspondence to Kiyohiko Sakata.

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Ethical approval

This study was approved by the ethics committee of the Kurume University School of Medicine (approval number: 18019).

Consent to participate

All patients concurred with the proposed treatment plan after all options for the management of acromegaly were clearly explained. Informed consent was obtained from all individual participants included in this study.

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All authors have read and approved the final manuscript.

Conflict of interest

The authors declare no competing interests.

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Sakata, K., Nagata, Y., Takeshige, N. et al. Early postoperative prediction of both disease remission and long-term disease control in acromegaly using the oral glucose tolerance test. Hormones 20, 515–526 (2021). https://doi.org/10.1007/s42000-021-00281-7

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