目的:在约三分之一的肢端肥大症患者中描述了葡萄糖负荷(GH-Par)后GH的矛盾升高。这里,我们评估了有和没有肢端肥大症的受试者的GH谱,旨在完善GH-Par的定义。
方法:观察性病例对照研究。
方法:我们的队列包括60例肢端肥大症患者,和两组受试者表现出抑制的GH(<0.4µg/L)和高(非acro^IGF-1,n=116)或正常的IGF-1水平(非acro,n=55)。从基线开始GH峰的分布≥120%,胰岛素,和葡萄糖水平在葡萄糖摄入后180分钟的时间间隔内进行评估。
结果:从120分钟开始,所有三组中相似比例的受试者的GH比率≥120%。重新考虑GH在90分钟内矛盾增加的定义,我们观察到,在肢端肥大症中,GH峰≥120%的患病率高于非-acro的IGF-1和非-acro的患病率(分别为42%,16%,7%,两者p<0.001)。在没有GH-Par的患者中,在曲线的第二部分观察到晚期GH反弹。较高的葡萄糖峰(p=0.038),加载后下降速度较慢,葡萄糖暴露量增加20%(p=0.015),以GH-Par为特征的肢端肥大症患者(相对于没有GH-Par的患者)的糖尿病患病率较高(p=0.003)。
结论:GH-Par反应可以定义为葡萄糖激发后的前90分钟增加20%。GH-Par,常见于肢端肥大症,并与葡萄糖代谢异常的患病率增加有关,在IGF-1水平较高的非肢端肥大症受试者的子集中也发现,表明它可能参与疾病的早期阶段。
OBJECTIVE: A paradoxical GH rise after the glucose load (GH-Par) is described in about one-third of acromegalic patients. Here, we evaluated the GH profile in subjects with and without acromegaly aiming to refine the definition of GH-Par.
METHODS: Observational case-control study.
METHODS: Our cohort consisted of 60 acromegalic patients, and two groups of subjects presenting suppressed GH (< 0.4 µg/L) and high (non-acro↑IGF-1, n = 116) or normal IGF-1 levels (non-acro, n = 55). The distribution of GH peaks ≥ 120% from baseline, insulin, and glucose levels were evaluated over a 180-min time interval after glucose intake.
RESULTS: A similar proportion of subjects in all three groups shows a GH ratio of ≥ 120% starting from 120 min. Re-considering the definition of paradoxical increase of GH within 90 min, we observed that the prevalence of GH peaks ≥ 120% was higher in acromegaly than in non-acro↑IGF-1 and non-acro (respectively 42%, 16%, and 7%, both p < 0.001). In patients without GH-Par, a late GH rebound was observed in the second part of the curve. Higher glucose peak (p = 0.038), slower decline after load, 20% higher glucose exposure (p = 0.015), and a higher prevalence of diabetes (p = 0.003) characterized acromegalic patients with GH-Par (with respect to those without).
CONCLUSIONS: GH-Par response may be defined as a 20% increase in the first 90 min after glucose challenge. GH-Par, common in acromegaly and associated with an increased prevalence of glucose metabolism abnormalities, is found also in a subset of non-acromegalic subjects with high IGF-1 levels, suggesting its possible involvement in the early phase of the disease.