GH deficiency in patients irradiated for acromegaly: Significance of GH stimulatory tests in relation to the 24 h GH secretion

A. A. van der Klaaw, A. M. Pereira, S. W. van Thiel, J. W A Smit, E. P M Corssmit, N. R. Biermasz, M. Frolich, A. Iranmanesh, Johannes D Veldhuis, F. Roelsfema, J. A. Romijn

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Abstract

Background: Radiotherapy for pituitary adenomas frequently leads to GH deficiency (GHD). The characteristics of GH secretion in GHD induced by postoperative radiotherapy for acromegaly are not known. Hypothesis: In the long term, stimulated and spontaneous GH release is not different between patients with GHD treated by postoperative radiotherapy for acromegaly or for other pituitary adenomas. Design/subjects: We compared the characteristics of basal and stimulated GH secretion in patients with GHD, who had previously received adjunct radiotherapy after surgery for GH-producing adenomas (n = 10) vs for other pituitary adenomas (n = 10). All patients had a maximal GH concentration by insulin tolerance test (ITT) of 3 μg/l or less, compatible with severe GHD. Mean time after radiation was 17 and 18.7 years, respectively. Stimulated GH release was also evaluated by infusion of growth hormone-releasing hormone (GHRH), GHRH-arginine and arginine, and spontaneous GH by 10 min blood sampling for 24 h. Pulse analyses were performed by Cluster and approximate entropy. Outcomes: T here were no differences between both patient groups in stimulated GH concentrations in any test. Spontaneous GH secretion was not different between both patient groups, including basal GH release, pulsatility and regularity. Pulsatile secretion was lost in two acromegalic and three non-acromegalic patients. Insulin-like growth factor-I (IGF-1) was below - 2 S.D. score in nine patients in each group. Conclusion: Acromegalic patients treated by surgery and postoper ative radiotherapy with an impaired response to the ITT do not differ, in the long term, in GH secretory characteristics from patients treated similarly for other pituitary tumors with an impaired response to the ITT. The ITT (or the GHRH-arginine test) is therefore reliable in establishing the diagnosis of GHD in patients treated for acromegaly by surgery and radiotherapy.

Original languageEnglish (US)
Pages (from-to)851-858
Number of pages8
JournalEuropean Journal of Endocrinology
Volume154
Issue number6
DOIs
StatePublished - Jun 2006

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Acromegaly
Radiotherapy
Pituitary Neoplasms
Growth Hormone-Releasing Hormone
Insulin
Arginine
Insulin-Like Growth Factor I
Entropy
Adenoma
Radiation

ASJC Scopus subject areas

  • Endocrinology

Cite this

van der Klaaw, A. A., Pereira, A. M., van Thiel, S. W., Smit, J. W. A., Corssmit, E. P. M., Biermasz, N. R., ... Romijn, J. A. (2006). GH deficiency in patients irradiated for acromegaly: Significance of GH stimulatory tests in relation to the 24 h GH secretion. European Journal of Endocrinology, 154(6), 851-858. https://doi.org/10.1530/eje.1.02163

GH deficiency in patients irradiated for acromegaly : Significance of GH stimulatory tests in relation to the 24 h GH secretion. / van der Klaaw, A. A.; Pereira, A. M.; van Thiel, S. W.; Smit, J. W A; Corssmit, E. P M; Biermasz, N. R.; Frolich, M.; Iranmanesh, A.; Veldhuis, Johannes D; Roelsfema, F.; Romijn, J. A.

In: European Journal of Endocrinology, Vol. 154, No. 6, 06.2006, p. 851-858.

Research output: Contribution to journalArticle

van der Klaaw, AA, Pereira, AM, van Thiel, SW, Smit, JWA, Corssmit, EPM, Biermasz, NR, Frolich, M, Iranmanesh, A, Veldhuis, JD, Roelsfema, F & Romijn, JA 2006, 'GH deficiency in patients irradiated for acromegaly: Significance of GH stimulatory tests in relation to the 24 h GH secretion', European Journal of Endocrinology, vol. 154, no. 6, pp. 851-858. https://doi.org/10.1530/eje.1.02163
van der Klaaw, A. A. ; Pereira, A. M. ; van Thiel, S. W. ; Smit, J. W A ; Corssmit, E. P M ; Biermasz, N. R. ; Frolich, M. ; Iranmanesh, A. ; Veldhuis, Johannes D ; Roelsfema, F. ; Romijn, J. A. / GH deficiency in patients irradiated for acromegaly : Significance of GH stimulatory tests in relation to the 24 h GH secretion. In: European Journal of Endocrinology. 2006 ; Vol. 154, No. 6. pp. 851-858.
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abstract = "Background: Radiotherapy for pituitary adenomas frequently leads to GH deficiency (GHD). The characteristics of GH secretion in GHD induced by postoperative radiotherapy for acromegaly are not known. Hypothesis: In the long term, stimulated and spontaneous GH release is not different between patients with GHD treated by postoperative radiotherapy for acromegaly or for other pituitary adenomas. Design/subjects: We compared the characteristics of basal and stimulated GH secretion in patients with GHD, who had previously received adjunct radiotherapy after surgery for GH-producing adenomas (n = 10) vs for other pituitary adenomas (n = 10). All patients had a maximal GH concentration by insulin tolerance test (ITT) of 3 μg/l or less, compatible with severe GHD. Mean time after radiation was 17 and 18.7 years, respectively. Stimulated GH release was also evaluated by infusion of growth hormone-releasing hormone (GHRH), GHRH-arginine and arginine, and spontaneous GH by 10 min blood sampling for 24 h. Pulse analyses were performed by Cluster and approximate entropy. Outcomes: T here were no differences between both patient groups in stimulated GH concentrations in any test. Spontaneous GH secretion was not different between both patient groups, including basal GH release, pulsatility and regularity. Pulsatile secretion was lost in two acromegalic and three non-acromegalic patients. Insulin-like growth factor-I (IGF-1) was below - 2 S.D. score in nine patients in each group. Conclusion: Acromegalic patients treated by surgery and postoper ative radiotherapy with an impaired response to the ITT do not differ, in the long term, in GH secretory characteristics from patients treated similarly for other pituitary tumors with an impaired response to the ITT. The ITT (or the GHRH-arginine test) is therefore reliable in establishing the diagnosis of GHD in patients treated for acromegaly by surgery and radiotherapy.",
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T2 - Significance of GH stimulatory tests in relation to the 24 h GH secretion

AU - van der Klaaw, A. A.

AU - Pereira, A. M.

AU - van Thiel, S. W.

AU - Smit, J. W A

AU - Corssmit, E. P M

AU - Biermasz, N. R.

AU - Frolich, M.

AU - Iranmanesh, A.

AU - Veldhuis, Johannes D

AU - Roelsfema, F.

AU - Romijn, J. A.

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N2 - Background: Radiotherapy for pituitary adenomas frequently leads to GH deficiency (GHD). The characteristics of GH secretion in GHD induced by postoperative radiotherapy for acromegaly are not known. Hypothesis: In the long term, stimulated and spontaneous GH release is not different between patients with GHD treated by postoperative radiotherapy for acromegaly or for other pituitary adenomas. Design/subjects: We compared the characteristics of basal and stimulated GH secretion in patients with GHD, who had previously received adjunct radiotherapy after surgery for GH-producing adenomas (n = 10) vs for other pituitary adenomas (n = 10). All patients had a maximal GH concentration by insulin tolerance test (ITT) of 3 μg/l or less, compatible with severe GHD. Mean time after radiation was 17 and 18.7 years, respectively. Stimulated GH release was also evaluated by infusion of growth hormone-releasing hormone (GHRH), GHRH-arginine and arginine, and spontaneous GH by 10 min blood sampling for 24 h. Pulse analyses were performed by Cluster and approximate entropy. Outcomes: T here were no differences between both patient groups in stimulated GH concentrations in any test. Spontaneous GH secretion was not different between both patient groups, including basal GH release, pulsatility and regularity. Pulsatile secretion was lost in two acromegalic and three non-acromegalic patients. Insulin-like growth factor-I (IGF-1) was below - 2 S.D. score in nine patients in each group. Conclusion: Acromegalic patients treated by surgery and postoper ative radiotherapy with an impaired response to the ITT do not differ, in the long term, in GH secretory characteristics from patients treated similarly for other pituitary tumors with an impaired response to the ITT. The ITT (or the GHRH-arginine test) is therefore reliable in establishing the diagnosis of GHD in patients treated for acromegaly by surgery and radiotherapy.

AB - Background: Radiotherapy for pituitary adenomas frequently leads to GH deficiency (GHD). The characteristics of GH secretion in GHD induced by postoperative radiotherapy for acromegaly are not known. Hypothesis: In the long term, stimulated and spontaneous GH release is not different between patients with GHD treated by postoperative radiotherapy for acromegaly or for other pituitary adenomas. Design/subjects: We compared the characteristics of basal and stimulated GH secretion in patients with GHD, who had previously received adjunct radiotherapy after surgery for GH-producing adenomas (n = 10) vs for other pituitary adenomas (n = 10). All patients had a maximal GH concentration by insulin tolerance test (ITT) of 3 μg/l or less, compatible with severe GHD. Mean time after radiation was 17 and 18.7 years, respectively. Stimulated GH release was also evaluated by infusion of growth hormone-releasing hormone (GHRH), GHRH-arginine and arginine, and spontaneous GH by 10 min blood sampling for 24 h. Pulse analyses were performed by Cluster and approximate entropy. Outcomes: T here were no differences between both patient groups in stimulated GH concentrations in any test. Spontaneous GH secretion was not different between both patient groups, including basal GH release, pulsatility and regularity. Pulsatile secretion was lost in two acromegalic and three non-acromegalic patients. Insulin-like growth factor-I (IGF-1) was below - 2 S.D. score in nine patients in each group. Conclusion: Acromegalic patients treated by surgery and postoper ative radiotherapy with an impaired response to the ITT do not differ, in the long term, in GH secretory characteristics from patients treated similarly for other pituitary tumors with an impaired response to the ITT. The ITT (or the GHRH-arginine test) is therefore reliable in establishing the diagnosis of GHD in patients treated for acromegaly by surgery and radiotherapy.

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