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Bioletto F, Sibilla M, Gasco V, Ghigo E, Grottoli S. Excess mortality in patients with non-functioning pituitary adenoma: a systematic review and meta-analysis. J Endocrinol Invest 2024:10.1007/s40618-024-02356-9. [PMID: 38503992 DOI: 10.1007/s40618-024-02356-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 03/03/2024] [Indexed: 03/21/2024]
Abstract
BACKGROUND Patients with non-functioning pituitary adenoma (NFPA) often present with a variety of clinical manifestations and comorbidities, mainly determined by the local mass effect of the tumor and by hypopituitarism. Whether this has an impact on overall mortality, however, is still unclear. METHODS PubMed/Medline, EMBASE, and Cochrane Library databases were systematically searched until May 2023 for studies reporting data either about standardized mortality ratios (SMRs) or about predictors of mortality in patients with NFPA. Effect sizes were pooled through a random-effect model. This systematic review and meta-analysis was registered in the International Prospective Register of Systematic Reviews (PROSPERO, #CRD42023417782). RESULTS Eleven studies were eligible for inclusion in the systematic review; among these, five studies reported data on SMRs, with a total follow-up time of approximately 130,000 person-years. Patients with NFPA showed an increased mortality risk compared to the general population (SMR = 1.57 [95%CI: 1.20-1.99], p < 0.01). Age and sex appeared to act as effect modifiers, with a trend towards higher SMRs in females (SMR = 1.57 [95%CI: 0.91-2.41], p = 0.10) than in males (SMR = 1.00 [95%CI: 0.89-1.11], p = 0.97), and in patients diagnosed at age 40 years or younger (SMR = 3.19 [95%CI: 2.50-3.97], p < 0.01) compared to those with later onset of the disease (SMR = 1.26 [95%CI: 0.93-1.65], p = 0.13). The trend towards excess mortality was similar in patients with normal (SMR = 1.22 [95%CI: 0.94-1.53], p = 0.13) or deficient (SMR = 1.26 [95%CI: 0.82-1.79], p = 0.27) pituitary function. CONCLUSIONS Excess mortality is observed in patients with NFPA, regardless of pituitary function, especially in women and in patients with a younger age at diagnosis.
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Affiliation(s)
- F Bioletto
- Endocrinology, Diabetes and Metabolism, Department of Medical Sciences, University of Turin, Corso Dogliotti 14, Turin, 10126, Italy.
| | - M Sibilla
- Endocrinology, Diabetes and Metabolism, Department of Medical Sciences, University of Turin, Corso Dogliotti 14, Turin, 10126, Italy
| | - V Gasco
- Endocrinology, Diabetes and Metabolism, Department of Medical Sciences, University of Turin, Corso Dogliotti 14, Turin, 10126, Italy
| | - E Ghigo
- Endocrinology, Diabetes and Metabolism, Department of Medical Sciences, University of Turin, Corso Dogliotti 14, Turin, 10126, Italy
| | - S Grottoli
- Endocrinology, Diabetes and Metabolism, Department of Medical Sciences, University of Turin, Corso Dogliotti 14, Turin, 10126, Italy
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Varaldo E, Sibilla M, Bioletto F, Cuboni D, Prencipe N, Bona C, Ferrari M, Viglino F, Aversa LS, Grottoli S, Ghigo E, Gasco V, Berton AM. Neuroendocrine response to diclofenac in healthy subjects: a pilot study. J Endocrinol Invest 2023; 46:2617-2627. [PMID: 37243865 PMCID: PMC10632215 DOI: 10.1007/s40618-023-02118-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 05/16/2023] [Indexed: 05/29/2023]
Abstract
PURPOSE The precise effects of non-steroidal anti-inflammatory drugs on the neuroendocrine hydro-electrolytic regulation are not precisely understood. The aim of this pilot study was to evaluate, in healthy subjects, the neuroendocrine response of the antidiuretic system to intravenous diclofenac infusion. METHODS For this single-blinded, cross-over study, we recruited 12 healthy subjects (50% women). Test sessions were divided into three observation times (pre-test; test; 48 h post-test), which were repeated equally on two different occasions, with the administration of diclofenac (75 mg in saline solution 0.9% 100 cc) on 1 day, or placebo (saline solution 0.9% 100 cc) on another day. The night before the test the subjects were asked to collect a salivary cortisol and cortisone sample, which was repeated on the night of the procedure session. Serial urine and blood samples were collected on the test day (for osmolality, electrolytes, ACTH, cortisol, copeptin, MR-proADM, MR-proANP; the last three represent more stable and analytically reliable molecules than their respective active peptides). Moreover, the subjects were evaluated with the bioimpedance vector analysis (BIVA) before and after the test. Forty-eight hours after the end of the procedure urine sodium, urine potassium, urine osmolality, serum sodium and copeptin were revaluated together with BIVA. RESULTS No significant changes in circulating hormone levels were observed; anyway, 48 h after diclofenac, BIVA showed a significant water retention (p < 0.00001), especially in extracellular fluid (ECF) (16.47 ± 1.65 vs 15.67 ± 1.84, p < 0.001). Salivary cortisol and cortisone tended to increase only the night after placebo administration (p = 0.054 cortisol; p = 0.021 cortisone). CONCLUSION Diclofenac resulted in an increased ECF at 48 h, but this phenomenon seems to be associated with a greater renal sensibility to the action of vasopressin rather than with an increase in its secretion. Moreover, a partial inhibitory effect on cortisol secretion can be hypothesized.
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Affiliation(s)
- E Varaldo
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, C.So Dogliotti 14, 10126, Turin, Italy
| | - M Sibilla
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, C.So Dogliotti 14, 10126, Turin, Italy.
| | - F Bioletto
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, C.So Dogliotti 14, 10126, Turin, Italy
| | - D Cuboni
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, C.So Dogliotti 14, 10126, Turin, Italy
| | - N Prencipe
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, C.So Dogliotti 14, 10126, Turin, Italy
| | - C Bona
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, C.So Dogliotti 14, 10126, Turin, Italy
| | - M Ferrari
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, C.So Dogliotti 14, 10126, Turin, Italy
| | - F Viglino
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, C.So Dogliotti 14, 10126, Turin, Italy
| | - L S Aversa
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, C.So Dogliotti 14, 10126, Turin, Italy
| | - S Grottoli
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, C.So Dogliotti 14, 10126, Turin, Italy
| | - E Ghigo
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, C.So Dogliotti 14, 10126, Turin, Italy
| | - V Gasco
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, C.So Dogliotti 14, 10126, Turin, Italy
| | - A M Berton
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, C.So Dogliotti 14, 10126, Turin, Italy
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Gasco V, Cuboni D, Varaldo E, Bioletto F, Berton AM, Bona C, Prencipe N, Ghigo E, Maccario M, Grottoli S. GHRH + arginine test and body mass index: do we need to review diagnostic criteria for GH deficiency? J Endocrinol Invest 2023; 46:2175-2183. [PMID: 37062055 PMCID: PMC10514141 DOI: 10.1007/s40618-023-02081-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 03/27/2023] [Indexed: 04/17/2023]
Abstract
INTRODUCTION The proportion of patients with low GH response to provocative tests increases with the number of other pituitary hormone deficiencies, reason why in panhypopituitary patients GH stimulation tests may be unnecessary to diagnose GH deficiency (GHD) PURPOSE: To re-evaluate the diagnostic cut-offs of GH response to GHRH + arginine (ARG) test related to BMI, considering the patients' pituitary function as the gold standard for the diagnosis of GHD. METHODS The GH responses to GHRH + ARG were studied in 358 patients with history of hypothalamic-pituitary disease. GHD was defined by the presence of at least 3 other pituitary deficits (n = 223), while a preserved somatotropic function was defined by the lack of other pituitary deficits and an IGF-I SDS ≥ 0 (n = 135). The cut-off with the best sensitivity (SE) and specificity (SP), was identified for each BMI category using the ROC curve analysis. To avoid over-diagnosis of GHD we subsequently searched for the cut-offs with a SP ≥ 95%. RESULTS The best GH cut-off was 8.0 μg/l (SE 95%, SP 100%) in lean, 7.0 μg/l (SE 97.3%, SP 82.8%) in overweight, and 2.8 μg/l (SE 84.3%, SP 91.7%) in obese subjects. The cut-off with a SP ≥ 95% was 2.6 μg/l (SE 68.5%, SP 96.6%) in overweight and 1.75 μg/l (SE 70.0%, SP 97.2%) in obese subjects. CONCLUSIONS This is the first study that evaluates the diagnostic cut-offs of GH response to GHRH + ARG related to BMI using a clinical definition of GHD as gold standard. Our results suggest that with this new approach, the GHRH + ARG cut-offs should be revised to avoid GHD over-diagnosis.
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Affiliation(s)
- V. Gasco
- Department of Medical Science, Division of Endocrinology, Diabetes and Metabolism, University of Turin, Turin, Italy
| | - D. Cuboni
- Department of Medical Science, Division of Endocrinology, Diabetes and Metabolism, University of Turin, Turin, Italy
| | - E. Varaldo
- Department of Medical Science, Division of Endocrinology, Diabetes and Metabolism, University of Turin, Turin, Italy
| | - F. Bioletto
- Department of Medical Science, Division of Endocrinology, Diabetes and Metabolism, University of Turin, Turin, Italy
| | - A. M. Berton
- Department of Medical Science, Division of Endocrinology, Diabetes and Metabolism, University of Turin, Turin, Italy
| | - C. Bona
- Department of Medical Science, Division of Endocrinology, Diabetes and Metabolism, University of Turin, Turin, Italy
| | - N. Prencipe
- Department of Medical Science, Division of Endocrinology, Diabetes and Metabolism, University of Turin, Turin, Italy
| | - E. Ghigo
- Department of Medical Science, Division of Endocrinology, Diabetes and Metabolism, University of Turin, Turin, Italy
| | - M. Maccario
- Department of Medical Science, Division of Endocrinology, Diabetes and Metabolism, University of Turin, Turin, Italy
| | - S. Grottoli
- Department of Medical Science, Division of Endocrinology, Diabetes and Metabolism, University of Turin, Turin, Italy
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Bioletto F, Berton AM, Varaldo E, Cuboni D, Bona C, Parasiliti-Caprino M, Prencipe N, Ghigo E, Grottoli S, Maccario M, Gasco V. Development and internal validation of a predictive score for the diagnosis of central adrenal insufficiency when morning cortisol is in the grey zone. J Endocrinol Invest 2023; 46:535-543. [PMID: 36161398 PMCID: PMC9938019 DOI: 10.1007/s40618-022-01926-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 09/17/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND When evaluating a patient for central adrenal insufficiency (CAI), there is a wide range of morning cortisol values for which no definite conclusion on hypothalamus-pituitary-adrenal (HPA) axis function can be drawn; in these cases, a stimulation test is required. Aim of this study was to develop an integrated model for CAI prediction when morning cortisol is in the grey zone, here defined as 40.0-160.0 μg/L. METHODS Overall, 119 patients with history of sellar tumour which underwent insulin tolerance test (ITT) for the evaluation of HPA axis were enrolled. Supervised regression techniques were used for model development. RESULTS An integrated predictive model was developed and internally validated, and showed a significantly better diagnostic performance than morning cortisol alone (AUC 0.811 vs 0.699, p = 0.003). A novel predictive score (CAI-score) was retrieved, on a 5.5-point scale, by considering morning cortisol (0 points if 130.1-160.0 μg/L, 1 point if 100.1-130.0 μg/L, 1.5 points if 70.1-100.0 μg/L, 2.5 points if 40.0-70.0 μg/L), other pituitary deficits (2 points if ≥ 3 deficits), and sex (1 point if male). A diagnostic algorithm integrating CAI-score and ITT was finally proposed, with an overall accuracy of 99%, and the possibility to avoid the execution of stimulation tests in 25% of patients. CONCLUSIONS This was the first study that proposed an integrated score for the prediction of CAI when morning cortisol is in the grey zone. This score might be helpful to reduce the number of patients who need a stimulation test for the assessment of HPA axis function.
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Affiliation(s)
- F Bioletto
- Endocrinology, Diabetology and Metabolism; Department of Medical Sciences, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy.
| | - A M Berton
- Endocrinology, Diabetology and Metabolism; Department of Medical Sciences, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy
| | - E Varaldo
- Endocrinology, Diabetology and Metabolism; Department of Medical Sciences, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy
| | - D Cuboni
- Endocrinology, Diabetology and Metabolism; Department of Medical Sciences, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy
| | - C Bona
- Endocrinology, Diabetology and Metabolism; Department of Medical Sciences, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy
| | - M Parasiliti-Caprino
- Endocrinology, Diabetology and Metabolism; Department of Medical Sciences, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy
| | - N Prencipe
- Endocrinology, Diabetology and Metabolism; Department of Medical Sciences, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy
| | - E Ghigo
- Endocrinology, Diabetology and Metabolism; Department of Medical Sciences, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy
| | - S Grottoli
- Endocrinology, Diabetology and Metabolism; Department of Medical Sciences, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy
| | - M Maccario
- Endocrinology, Diabetology and Metabolism; Department of Medical Sciences, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy
| | - V Gasco
- Endocrinology, Diabetology and Metabolism; Department of Medical Sciences, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy
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5
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Bona C, Prencipe N, Berton AM, Bioletto F, Parasiliti-Caprino M, Gasco V, Ghigo E, Grottoli S. Mean GH profile is more accurate than single fasting GH in the evaluation of acromegaly disease control during somatostatin receptor ligands therapy. J Endocrinol Invest 2022; 45:1955-1965. [PMID: 35748978 PMCID: PMC9463242 DOI: 10.1007/s40618-022-01830-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 05/28/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE This study aims to compare the accuracy of mean GH profile (GHP) < 2.5 ng/ml and single fasting GH (SGH) < 1 ng/ml in the evaluation of disease control in acromegaly patients during somatostatin receptor ligands (SRLs) therapy. METHODS We retrospectively enrolled 100 acromegaly patients, 68 responder, and 32 partial responder to SRLs. Controlled disease has been defined as IGF-I levels within age-related normal limits, while partial response as pathological IGF-I values despite a reduction ≥ 50%. In all patients, GHP, SGH, IGF-I, and IGFBP-3 were evaluated. RESULTS Median GHP levels (1.2 ng/ml, IQR 0.5-2.3 ng/ml) were lower (p = 0.001) than SGH (1.9 ng/ml, IQR 1.0-3.6 ng/ml). Accuracy of GHP was 81%, whereas that of SGH was 55%, with a Kappa index of 0.520 and 0.237, respectively. In multivariable analysis GHP (p = 0.002) and IGFBP-3 (p = 0.004), but not SGH, were independently associated with normal IGF-I levels. At receiver-operator characteristic curve (ROC) analysis GHP cut-off sensitivity and specificity were 94.1% and 50.0%, respectively, while SGH sensitivity and specificity were 35.3% and 93.7%, respectively. Finally, in obese patients the GH cut-off level (both as SGH and GHP) associated to good disease control was significantly different with respect to not obese ones. CONCLUSIONS GHP associates with IGF-I (and therefore with appropriate control of disease) with higher accuracy than SGH. When GH evaluation is needed, the measurement of mean GHP should be preferred and use of BMI-related cut-offs is suggested.
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Affiliation(s)
- C Bona
- Division of Endocrinology, Diabetology and Metabolism, Medical Science Department, University Hospital "Città della Salute e della Scienza di Torino", Corso Dogliotti 14, 10126, Turin, Italy.
| | - N Prencipe
- Division of Endocrinology, Diabetology and Metabolism, Medical Science Department, University Hospital "Città della Salute e della Scienza di Torino", Corso Dogliotti 14, 10126, Turin, Italy
| | - A M Berton
- Division of Endocrinology, Diabetology and Metabolism, Medical Science Department, University Hospital "Città della Salute e della Scienza di Torino", Corso Dogliotti 14, 10126, Turin, Italy
| | - F Bioletto
- Division of Endocrinology, Diabetology and Metabolism, Medical Science Department, University Hospital "Città della Salute e della Scienza di Torino", Corso Dogliotti 14, 10126, Turin, Italy
| | - M Parasiliti-Caprino
- Division of Endocrinology, Diabetology and Metabolism, Medical Science Department, University Hospital "Città della Salute e della Scienza di Torino", Corso Dogliotti 14, 10126, Turin, Italy
| | - V Gasco
- Division of Endocrinology, Diabetology and Metabolism, Medical Science Department, University Hospital "Città della Salute e della Scienza di Torino", Corso Dogliotti 14, 10126, Turin, Italy
| | - E Ghigo
- Division of Endocrinology, Diabetology and Metabolism, Medical Science Department, University Hospital "Città della Salute e della Scienza di Torino", Corso Dogliotti 14, 10126, Turin, Italy
| | - S Grottoli
- Division of Endocrinology, Diabetology and Metabolism, Medical Science Department, University Hospital "Città della Salute e della Scienza di Torino", Corso Dogliotti 14, 10126, Turin, Italy
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Barale M, Massano M, Bioletto F, Maiorino F, Pusterla A, Mazzetti R, Trentini L, Bonora S, Di Perri G, Ghigo E, Procopio M. Sex-specific fat mass ratio cutoff value identifies a high prevalence of cardio-metabolic disorders in people living with HIV. Nutr Metab Cardiovasc Dis 2022; 32:1936-1943. [PMID: 35680489 DOI: 10.1016/j.numecd.2022.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 05/05/2022] [Accepted: 05/06/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIMS HIV-associated lipodystrophy syndrome (HALS) contributes to the increased cardiovascular risk connoting people living with HIV (PLHIV). HALS recognition, based on clinical ground, may be inaccurate urging an objective instrumental diagnosis. The aim of this study is to search for the DXA-derived fat mass ratio (FMR) threshold, among those suggested for the diagnosis of HALS, able to identify PLHIV at high cardiovascular risk. METHODS AND RESULTS In a cross-sectional analysis of 101 PLHIV (age 53 ± 11 years, men 55%) and 101 age- and sex-matched uninfected controls, DXA-derived FMR and anthropometric as well as cardio-metabolic parameters were assessed. PLHIV showed a higher FMR (1.15 ± 0.42 vs 0.95 ± 0.18, p < 0.01) together with a greater cardio-metabolic derangement than controls, in spite of lower BMI (24.3 ± 4.3 vs 26.9 ± 4.0 kg/m2, p < 0.01) and fat mass index (FMI, 6.6 ± 3.0 vs 9.2 ± 3.1 kg/m2, p < 0.01). Particularly, PLHIV with HALS (n = 28), defined as those with a FMR above 1.260 and 1.329 for men and women, respectively, had a greater prevalence of type 2 diabetes mellitus (18% vs 1%), insulin resistance (68% vs 27%), hypertriglyceridemia (50% vs 29%), hypertension (61% vs 30%) and metabolic syndrome (32% vs 10%) than those without HALS (p < 0.05 for all comparisons) and controls. At multivariate analyses, FMR in PLHIV was significantly associated (p < 0.05) with fasting glucose (β [95%CI] = 0.5, [0.1-0.9]), insulin (44.6, [14.9-74.2]), HOMA-IR (1.6, [0.5-2.7]), triglycerides (1.0, [ 0.2-1.8]) and HDL-cholesterol (-2.1, [-3.9/-0.4]) levels. CONCLUSION Sex-specific FMR thresholds, proposed for diagnosis of HALS, could represent new indices of cardio-metabolic derangement in PLHIV.
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Affiliation(s)
- M Barale
- Division of Endocrinology, Diabetology and Metabolic Diseases, Department of General and Specialty Medicine, Molinette Hospital, University of Turin - Cso Dogliotti, 14-10126, Turin, Italy.
| | - M Massano
- Division of Endocrinology, Diabetology and Metabolic Diseases, Department of General and Specialty Medicine, Molinette Hospital, University of Turin - Cso Dogliotti, 14-10126, Turin, Italy
| | - F Bioletto
- Division of Endocrinology, Diabetology and Metabolic Diseases, Department of General and Specialty Medicine, Molinette Hospital, University of Turin - Cso Dogliotti, 14-10126, Turin, Italy
| | - F Maiorino
- Division of Endocrinology, Diabetology and Metabolic Diseases, Department of General and Specialty Medicine, Molinette Hospital, University of Turin - Cso Dogliotti, 14-10126, Turin, Italy
| | - A Pusterla
- Division of Endocrinology, Diabetology and Metabolic Diseases, Department of General and Specialty Medicine, Molinette Hospital, University of Turin - Cso Dogliotti, 14-10126, Turin, Italy
| | - R Mazzetti
- Radiology Unit, Department of Diagnostic Imaging and Interventional Radiology, Molinette Hospital, University of Turin - Cso Dogliotti, 14-10126, Turin, Italy
| | - L Trentini
- Unit of Infectious Diseases, Department of Medical Sciences, Amedeo di Savoia Hospital, University of Turin - Corso Svizzera, 164-10149, Turin, Italy
| | - S Bonora
- Unit of Infectious Diseases, Department of Medical Sciences, Amedeo di Savoia Hospital, University of Turin - Corso Svizzera, 164-10149, Turin, Italy
| | - G Di Perri
- Unit of Infectious Diseases, Department of Medical Sciences, Amedeo di Savoia Hospital, University of Turin - Corso Svizzera, 164-10149, Turin, Italy
| | - E Ghigo
- Division of Endocrinology, Diabetology and Metabolic Diseases, Department of General and Specialty Medicine, Molinette Hospital, University of Turin - Cso Dogliotti, 14-10126, Turin, Italy
| | - M Procopio
- Division of Endocrinology, Diabetology and Metabolic Diseases, Department of General and Specialty Medicine, Molinette Hospital, University of Turin - Cso Dogliotti, 14-10126, Turin, Italy
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7
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Bioletto F, Prencipe N, Berton AM, Bona C, Varaldo E, Gasco V, Ghigo E, Grottoli S. Optimal timing of blood samplings to detect GH inhibition during oral glucose tolerance test. J Endocrinol Invest 2022; 45:981-987. [PMID: 35098493 DOI: 10.1007/s40618-021-01731-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 12/21/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND In patients with suspected acromegaly, evaluation of IGF-I is recommended as first-line test, while the assessment of GH-nadir during oral glucose tolerance test (OGTT) is advised as confirmatory test. The procedure of this test generally involves GH measurement every 30 min (30') from baseline to +120' or +180'. However, the optimal timing of samplings for the distinction between patients with or without active acromegaly is still a matter of debate. METHODS Sixty-seven healthy subjects and 46 acromegalic patients who achieved documented and persistent long-term cure were enrolled. A greedy algorithm was used to identify the minimal subset of time-points that sufficed to correctly detect GH suppression. RESULTS The sampling at 90' was the one in which a GH level < 1 μg/L was most frequently achieved (i.e., in 91.3% of cured acromegalic patients and in 91.0% of healthy subjects). Considering the whole cohort, the best combination of 2 time-points was +90' and +150' and achieved 95.6% accuracy; the best combination of 3 time-points was +60', +90' and +150' and achieved 99.1% accuracy. The minimal subset of GH determinations that demonstrated perfect accuracy (100%) needed the inclusion of 4 time-points, namely +60', +90', +120' and +150'. CONCLUSION A subset of 4 time-points (60' - 90' - 120' - 150') was identified as the most relevant to detect GH suppression at OGTT, with a perfect classification of 100% of subjects. This supports the possibility to restrict the blood samplings to these time-points when assessing disease cure, with possible advantages in terms of saving time and lowering costs.
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Affiliation(s)
- F Bioletto
- Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy.
| | - N Prencipe
- Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy
| | - A M Berton
- Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy
| | - C Bona
- Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy
| | - E Varaldo
- Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy
| | - V Gasco
- Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy
| | - E Ghigo
- Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy
| | - S Grottoli
- Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy
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