ArticlePituitary2021
Prognostic value of nadir GH levels for long-term biochemical remission or recurrence in surgically treated acromegaly.
Article in Pituitary, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers, 1 of them a synthesis that pooled it.
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Who cites it
9 citing papers in PubMed, 1 synthesis or guideline pooled it, 22 citations in OpenAlex.
- Recurrent acromegaly: a systematic review on therapeutic approaches.BMC endocrine disorders · 2024Pooled it
- Long-term clinical control in acromegaly patients with postoperative discordant nadir growth hormone during oral glucose tolerance test and insulin-like growth factor 1 levels: a retrospective observational study and literature review.Langenbeck's archives of surgery · 2025Observational
- Consensus on acromegaly therapeutic outcomes: an update.Nature reviews. Endocrinology · 2025Review
- Prospective, Longitudinal Study of Cancer Predictors and Rates in a New York City Cohort of 598 Patients With Acromegaly.The Journal of clinical endocrinology and metabolism · 2025Article
- Acromegaly: diagnostic challenges and individualized treatment.Expert review of endocrinology & metabolism · 2025Review
- Recurrence in acromegaly: two tertiary centers experience and review of the literature.Journal of endocrinological investigation · 2024Review
- Predictors of Remission of Acromegaly following Surgical Treatment in Growth Hormone-Secreting Pituitary Adenoma.Journal of neurological surgery. Part B, Skull base · 2024Article
- Consensus on criteria for acromegaly diagnosis and remission.Pituitary · 2024Article
- Article
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Authors and funding
9 authors at 2 institutions in 1 country.
Funding
Abstract
contextOutcome of acromegaly surgery is assessed by IGF-1 and glucose-suppressed GH, but whether the latter provides additional clinically relevant information when IGF-1 is normal is unclear. The role of GH suppression testing after surgery requires clarification.
methodsWe studied 97 acromegaly patients with normal IGF-1 after surgery by measuring GH after oral glucose longitudinally, initially at ≥ 3 months after surgery and repeated one or more times ≥ 1 year later. Nadir GH was categorized as normal or abnormal relative to the 97.5th percentile of nadir GH in 100 healthy subjects, which were ≤ 0.14 µg/L (DSL IRMA) or ≤ 0.15 µg/L(IDS iSYS). Signs and symptoms scores and insulin resistance were followed longitudinally.
resultsOf 68 patients with initial normal GH suppression 63 (93%) remained in remission and of 29 with initial abnormal GH suppression, 9 (31%) recurred. Recurrence was more common in patients with abnormal suppression (P < 0.001). A total of 14 patients recurred, including 5 with normal GH suppression progressing to abnormal and then recurrence. Overall, serial signs and symptoms and insulin resistance assessments did not identify patients with abnormal suppression or recurrence.
conclusionRisk of recurrence after surgery is increased for patients with a normal IGF-1 level, but abnormal GH suppression. We newly find, using both our and others' cut-offs, that while normal suppression predicts long-term remission in most patients, some can progress from normal to abnormal suppression and then recurrence after many years of follow up. Nadir GH levels are of prognostic value in acromegaly patients with normal IGF-1 levels after surgery.
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