Abstract：
BACKGROUND: Excess growth hormone (GH) secretion in acromegaly has a major impact on mineral balance and serum phosphate levels. However, the clinical utilization of serum phosphate levels as a marker for long-term disease outcomes in acromegaly has not been evaluated.
METHODS: This is a retrospective study of patients with acromegaly who were followed in a tertiary center. Data were retrieved on patient characteristics, endocrine and biochemical evaluation, and tumor parameters. Comparisons were performed by measuring baseline phosphate levels and conducting correlation analysis and multivariable logistic regression.
RESULTS: Sixty-one patients were followed for 4.5 years (range 1-21). Patients with hyperphosphatemia (> 4.5 mg/dl) at baseline had larger adenomas (15.0 mm [8.0, 47.0] vs. 10.0 mm [3.0, 24.0], p = 0.001), a rate chance of invasive adenoma (16 [80.0%] vs. 14 [46.7%], p = 0.02), and lower serum cortisol levels (226.0 nmol/l [27.6, 516.0] vs. 294.0 nmol/l [32.0, 610.0], p = 0.02). Baseline serum phosphate levels positively correlated with IGF-1 levels (r = 0.43, p = 0.003) and negatively correlated with morning plasma cortisol levels (r = -0.46, p = 0.002). Regarding long-term impact, baseline phosphate levels correlated with the number of pituitary axes involved 6 months after diagnosis (r-0.34, p = 0.01). In multivariable analysis, baseline plasma phosphate levels were independently associated with risk for disease progression/recurrence (odds ratio [OR] 9.66, 95% confidence interval [CI] 1.5, 105.9, p = 0.03) and for invasive adenoma (OR 6.21, 95% CI 1.6, 28.7, p = 0.01).
CONCLUSIONS: Elevated pretreatment serum phosphate levels are associated with a greater risk of disease persistence and recurrence and with altered pituitary function in patients with acromegaly.
METHODS: This is a retrospective study of patients with acromegaly who were followed in a tertiary center. Data were retrieved on patient characteristics, endocrine and biochemical evaluation, and tumor parameters. Comparisons were performed by measuring baseline phosphate levels and conducting correlation analysis and multivariable logistic regression.
RESULTS: Sixty-one patients were followed for 4.5 years (range 1-21). Patients with hyperphosphatemia (> 4.5 mg/dl) at baseline had larger adenomas (15.0 mm [8.0, 47.0] vs. 10.0 mm [3.0, 24.0], p = 0.001), a rate chance of invasive adenoma (16 [80.0%] vs. 14 [46.7%], p = 0.02), and lower serum cortisol levels (226.0 nmol/l [27.6, 516.0] vs. 294.0 nmol/l [32.0, 610.0], p = 0.02). Baseline serum phosphate levels positively correlated with IGF-1 levels (r = 0.43, p = 0.003) and negatively correlated with morning plasma cortisol levels (r = -0.46, p = 0.002). Regarding long-term impact, baseline phosphate levels correlated with the number of pituitary axes involved 6 months after diagnosis (r-0.34, p = 0.01). In multivariable analysis, baseline plasma phosphate levels were independently associated with risk for disease progression/recurrence (odds ratio [OR] 9.66, 95% confidence interval [CI] 1.5, 105.9, p = 0.03) and for invasive adenoma (OR 6.21, 95% CI 1.6, 28.7, p = 0.01).
CONCLUSIONS: Elevated pretreatment serum phosphate levels are associated with a greater risk of disease persistence and recurrence and with altered pituitary function in patients with acromegaly.
摘要：
背景：肢端肥大症中生长激素（GH）的过量分泌对矿物质平衡和血清磷酸盐水平具有重大影响。然而,血清磷酸盐水平作为肢端肥大症长期疾病结局指标的临床应用尚未得到评估.
方法：这是一项在三级中心随访的肢端肥大症患者的回顾性研究。检索了有关患者特征的数据，内分泌和生化评估，和肿瘤参数。通过测量基线磷酸盐水平并进行相关分析和多变量逻辑回归进行比较。
结果：61例患者随访4.5年（范围1-21）。基线时高磷血症患者（>4.5mg/dl）有较大的腺瘤（15.0mm[8.0,47.0]vs.10.0mm[3.0,24.0],p=0.001),侵袭性腺瘤的发生率(16[80.0%]vs.14[46.7%]，p=0.02),和较低的血清皮质醇水平（226.0nmol/l[27.6,516.0]vs.294.0nmol/l[32.0,610.0],p=0.02)。基线血清磷酸盐水平与IGF-1水平呈正相关（r=0.43，p=0.003），与早晨血浆皮质醇水平呈负相关（r=-0.46，p=0.002）。关于长期影响，基线磷酸盐水平与诊断后6个月的垂体轴数相关(r-0.34,p=0.01).在多变量分析中，基线血浆磷酸盐水平与疾病进展/复发风险(比值比[OR]9.66,95%置信区间[CI]1.5,105.9,p=0.03)和侵袭性腺瘤风险(OR6.21,95%CI1.6,28.7,p=0.01)独立相关.
结论：在肢端肥大症患者中，治疗前血清磷酸盐水平升高与疾病持续和复发的风险增加以及垂体功能改变相关。
方法：这是一项在三级中心随访的肢端肥大症患者的回顾性研究。检索了有关患者特征的数据，内分泌和生化评估，和肿瘤参数。通过测量基线磷酸盐水平并进行相关分析和多变量逻辑回归进行比较。
结果：61例患者随访4.5年（范围1-21）。基线时高磷血症患者（>4.5mg/dl）有较大的腺瘤（15.0mm[8.0,47.0]vs.10.0mm[3.0,24.0],p=0.001),侵袭性腺瘤的发生率(16[80.0%]vs.14[46.7%]，p=0.02),和较低的血清皮质醇水平（226.0nmol/l[27.6,516.0]vs.294.0nmol/l[32.0,610.0],p=0.02)。基线血清磷酸盐水平与IGF-1水平呈正相关（r=0.43，p=0.003），与早晨血浆皮质醇水平呈负相关（r=-0.46，p=0.002）。关于长期影响，基线磷酸盐水平与诊断后6个月的垂体轴数相关(r-0.34,p=0.01).在多变量分析中，基线血浆磷酸盐水平与疾病进展/复发风险(比值比[OR]9.66,95%置信区间[CI]1.5,105.9,p=0.03)和侵袭性腺瘤风险(OR6.21,95%CI1.6,28.7,p=0.01)独立相关.
结论：在肢端肥大症患者中，治疗前血清磷酸盐水平升高与疾病持续和复发的风险增加以及垂体功能改变相关。
