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Divergence between Growth Hormone and Insulin-Like Growth Factor-I Concentrations in the Follow-Up of Acromegaly

Department of Endocrinology (O.A., D.M.), St. Luc University Hospital, Université Catholique de Louvain, B-1200 Brussels, Belgium; Department of Endocrinology (M.B.), Gasthuisberg University Hospital, Gasthuisberg, Katholieke Universiteit Leuven, B-3000, Leuven, Belgium; Department of Endocrinology (R.A.), University of Antwerp, B-2610 Antwerp, Belgium; Department of Endocrinology (G.T.), University Hospital of Gent, B-9000 Gent, Belgium; and Department of Endocrinology (B.V.), Academic Hospital Free University of Brussels, B-1090 Brussels, Belgium

Address all correspondence and requests for reprints to: Dr. O. Alexopoulou, Service d’Endocrinologie et Nutrition, Cliniques Universitaires St. Luc, Avenue Hippocrate 54, UCL 54.74, B-1200 Brussels, Belgium. E-mail: orsalia.alexopoulou{at}diab.ucl.ac.be.

Context: Divergence between GH and IGF-I values is regularly observed in treated acromegalic patients, and its significance is unclear.

Objectives: The objective of the study was to explore the frequency and identify potential determinants of discordant serum GH and IGF-I concentrations in noncured acromegalic patients.

Patients: Two hundred twenty-nine noncured acromegalic patients of the Belgian acromegaly registry (AcroBel) were grouped according to their mean GH level ( or > 2 µg/liter) and IGF-I z-score ( 2 or > 2). Clinical and metabolic parameters were compared between groups with active disease (high GH and IGF-I; n=81),high GH (with normal IGF-I; n=25), high IGF-I (with normal GH; n=55), and controlled disease (GH and IGF-I normal; n=68).

Results: Compared with the high IGF-I group, the high GH group was characterized by younger age (52 vs. 58 yr, P < 0.05), female predominance (72 vs. 36%, P < 0.01), and lower body mass index (25 vs. 31 kg/m²; P < 0.001), fasting glucose (91 vs. 99 mg/dl; P < 0.05), and glycated hemoglobin levels (5.7 vs. 6.1%; P < 0.01). There was no difference among the groups regarding baseline characteristics of pituitary adenoma, current medical treatment, or symptom score.

Conclusions: Thirty-five percent of noncured acromegalic patients exhibit a discordant GH and IGF-I pattern. The high GH phenotype was found predominantly in younger estrogen-sufficient females, implying a possible role for age, gender, and estrogens in this biochemical divergence. The high IGF-I phenotype was associated with a worse metabolic profile, suggesting that high IGF-I, rather than high GH, is indicative of persistently active disease.

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