PURPOSE: Postoperative assessment of acromegaly activity is typically performed at least 3months after neurosurgery (NS). Few studies have evaluated the use of early postoperative growth hormone (GH) levels as a test to predict short- and long-term remission of acromegaly. Our objective was to evaluate the diagnostic performance of serum random GH on a postoperative day one (D1-rGH) and two (D2-rGH), particularly in predicting long-term disease persistence.MATERIALS AND METHODS: Forty-one subjects with acromegaly who were undergoing NS were enrolled (mean age±SD 47.4±13.1years at diagnosis; women 54%; macroadenomas 71%). The final assessment of disease activity was performed one year after NS. ROC curves were used to evaluate the diagnostic performance of D1-rGH and D2-rGH.RESULTS: After a 1-year follow-up, the overall remission rate was 55%. ROC analysis identified an optimal D1-rGH cut-off value of 2.1ng/mL for diagnosing long-term disease persistence (55.6% SE; 90.9% SP). The cut-off point became 2.5ng/mL after maximizing specificity for disease persistence (yielding a 100% positive predictive value) and 0.3ng/mL after maximizing sensitivity for disease remission. The optimal D2-rGH cut-off value was 0.6ng/mL (81.8% SE; 50% SP); the cut-off point became 2.9ng/mL after maximizing specificity and 0.1ng/mL after maximizing sensitivity, with no clinical utility.CONCLUSIONS: D1-rGH could be a highly specific test for the early diagnosis of long-term acromegaly persistence, which is predicted by a value>2.5ng/mL with a great degree of certainty. The diagnostic performance of D2-rGH was insufficient. Further research is required to validate these preliminary results prior to modifying the postoperative management of acromegaly.

First but not second postoperative day growth hormone assessments as early predictive tests for long-term acromegaly persistence

Cambria, V
Co-first
;
Beccuti, G
Co-first
;
Prencipe, N;Penner, F;Gasco, V;Gatti, F;Romanisio, M;Ghigo, E;Zenga, F;Grottoli, S
Last
2021

Abstract

PURPOSE: Postoperative assessment of acromegaly activity is typically performed at least 3months after neurosurgery (NS). Few studies have evaluated the use of early postoperative growth hormone (GH) levels as a test to predict short- and long-term remission of acromegaly. Our objective was to evaluate the diagnostic performance of serum random GH on a postoperative day one (D1-rGH) and two (D2-rGH), particularly in predicting long-term disease persistence.MATERIALS AND METHODS: Forty-one subjects with acromegaly who were undergoing NS were enrolled (mean age±SD 47.4±13.1years at diagnosis; women 54%; macroadenomas 71%). The final assessment of disease activity was performed one year after NS. ROC curves were used to evaluate the diagnostic performance of D1-rGH and D2-rGH.RESULTS: After a 1-year follow-up, the overall remission rate was 55%. ROC analysis identified an optimal D1-rGH cut-off value of 2.1ng/mL for diagnosing long-term disease persistence (55.6% SE; 90.9% SP). The cut-off point became 2.5ng/mL after maximizing specificity for disease persistence (yielding a 100% positive predictive value) and 0.3ng/mL after maximizing sensitivity for disease remission. The optimal D2-rGH cut-off value was 0.6ng/mL (81.8% SE; 50% SP); the cut-off point became 2.9ng/mL after maximizing specificity and 0.1ng/mL after maximizing sensitivity, with no clinical utility.CONCLUSIONS: D1-rGH could be a highly specific test for the early diagnosis of long-term acromegaly persistence, which is predicted by a value>2.5ng/mL with a great degree of certainty. The diagnostic performance of D2-rGH was insufficient. Further research is required to validate these preliminary results prior to modifying the postoperative management of acromegaly.
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Acromegaly; Disease persistence; Early prediction; Growth hormone
Cambria, V; Beccuti, G; Prencipe, N; Penner, F; Gasco, V; Gatti, F; Romanisio, M; Caputo, M; Ghigo, E; Zenga, F; Grottoli, S
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2318/1785391
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