Revisiting the role of insulin-like growth factor-1 measurem
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In the management of growth hormone (GH)-secreting pituitary adenomas, oral glucose tolerance test (OGTT) has been the gold standard not only for diagnoses but also for the determination of biochemical remission. Insulin-like growth factor-1 (IGF-1) is an essential biomarker although it should be adjusted for both age and sex.

In this retrospective study, researchers evaluated whether IGF-1 levels could serve as a reliable alternative to an OGTT for disease monitoring after the surgical treatment of acromegaly.

They retrospectively reviewed the medical records of 320 patients who underwent surgical resection of their GH-secreting pituitary tumors. Receiver operator characteristic (ROC) analyses were performed to validate the accuracy of IGF-1 levels for the assessment of remission. In addition, regression analyses were performed to identify factors associated with discrepancy between OGTT and IGF-1 levels.

-- Except for 1 week after surgery, ROC analyses showed an area under the curve of greater than 0.8 for IGF-1 at all time points.

-- Of 320 patients, 270 achieved endocrine remission after surgery alone.

-- Among these patients, IGF-1 levels were normalized in 250 patients.

-- The mean duration from surgery to IGF-1 normalization was 4.7 months.

-- Regression analyses demonstrated that risk of failed IGF-1 normalization was increased by 3.1-fold when the tumor invaded the cavernous sinus and increased by 9.0-fold in patients with incomplete tumor removal.

Conclusively, IGF-1 level is a reliable alternative to OGTT and plays a valuable role in monitoring acromegaly status.

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