A Study on the Values of Static and Dynamic Biological Tests Used in the Diagnosis of Hypersomatotropinism and Its Complications

Year 1974, Volume: 27 Issue: 3-4 , 739 - 756 , 30.12.1974

Selahattin Koloğlu

https://izlik.org/JA69HZ63TX

Abstract

The role of routine, classic, and modern diagnostic tests in the diagnosis of active hypersomatotropinism was investigated by examining 80 cases of acromegaly.

Phosphoremia and diurnal variations in phosphorus levels did not provide significant information for diagnosis or for the determination of disease activity.

The examination of basal somatotropin (STH) levels was found to be useful in determining activity, except in 7.5% of the cases. It became apparent that at least two basal STH determinations in each case are essential for diagnosis.

In cases of 'forme fruste' or inactive acromegaly, and for monitoring the effectiveness of treatment in previously treated patients, early diagnosis is only possible through the dynamic study of STH secretion. In this regard, the determination of autonomous STH secretion via insulin stimulation and glucose suppression tests is the most significant evidence for disease activity. In contrast, demonstrating the stimulability and suppressibility of this secretion serves as the most crucial evidence for treatment effectiveness.

Keywords

Hypersomatotropinism , Acromegaly , Diabetes Mellitus

Ethical Statement

-

Supporting Institution

Ankara University Faculty of Medicine, Department of Endocrinology and Metabolic Diseases

Project Number

-

Thanks

-

Hipersomatotropinizm Ve Komplikasyonlarının Teşhisinde Yararlanılan Statik Ve Dinamik Biyolojik Testlerin Değerleri Üzerinde İnceleme

https://izlik.org/JA69HZ63TX

Abstract

80 akromegali vakası incelenerek, rutin, klasik ve modern teşhis testlerinin aktif hipersomatotropinizm teşhisindeki yeri araştırılmıştır.

Fosforemi ve fosfor seviyelerindeki diurnal değişiklikler teşhis bakımından veya aktivitenin meydana çıkarılışında; önemli bilgi sağlayamamıştır.

Bazal somatotropin (STH) seviyelerinin incelenmesi, vakaların % 7,5'u hariç, aktivitenin meydana çıkarılışında faydalı olmuştur. Her vakada en az iki bazal STH tayininin, teşhis bakımından, elzem olduğu meydana çıkmıştır.

Frust veya inaktivite safhasındaki bir akromegalide erken teşhis veya tedavi görmüş vakalarda tedavinin etkenliğinin takibi, ancak STH salgısının dinamik incelenmesile mümkündür. Bu bakımdan insülin stimülasyonu ve glikoz supresyonu ile STH salgısındaki otonominin tesbiti aktivite lehinde, aynı salgının stimulabilite ve supresibilitesinin meydana çıkarılışı ise tedavinin etkenliği lehinde en önemli delillerdir.

Keywords

Hipersomatotropinizm , Akromegali , Diabetes Mellitus

Ethical Statement

-

Supporting Institution

A. Ü. Tıp Fakültesi Endokrinoloji ve Metabolizma Hastalıkları Kürsüsü

Project Number

-

Thanks

-

References

• 1- Adams, J. E, et al. Transphenoidai cryohipophysectomy in acromegaly. Clinical and endocrinological evaluation. J. Neurosurg, 28: 100, 1958.
• 2- Alford, P., Baker, H. W. and Burger, H. G. The secretion rate of hu-man growth hormone 1 daily secretion rates, effect of posture and sleep. J. Clin. Endocr. and Meta, 37/4: 515, 1973.
• 3- Aparicio, N. J. et al. Circadian variation of the blood glucose, plasma insulin and human growth hormone levels in response to an oral glucose load in normal subjects. Diabetes, 23/2: 132, 1974.
• 4- Bachelot, I. et al: Régulation normale de la secretion de l'hormone de croissance chez une acromegalique guerie par excerese d'une tumeur hypophysaire. Anales d'endocrinologie. 34/4: 398, 1473.
• 5- Beck, D. et al. Correlative studies of growth hormone and insulin plasma concentrations with metabolic abnormalities in acromegaly. J. Lab. Clin. Med., 60: 366, 1965.
• 6- Best, J., Catt, K. J. and Burger, H. G. : Nonspecificity of orgininc infu-sion as a test for growth hormon secretion. Lancet, 2:124, 1968.
• 7- Boden, G. Soeldner, J., Steinke, J. Serum human growth hormone (HGH) response to IV glucose; diagnosis of acromegaly in females and males. Metabolism, 17:1, 1968.
• 8- Boden, G., et al. Elevated serum HGH and decreased insulin in pre-diabetic males after I V. tolbutamide and glucose. J. Clin. Invest 47: 729, 1968.
• 9- Boyd, A. E, Lebovitz, H. E. Pfeiffer, J. D. : Stimulation of human growth hormone secretion by L-DOPA New Eng. J. Med., 283 1425, 1970.
• 10- Bruno, O. D. Extra-adrenal action of metyrapone in man. Effects on plasma cortisol desappearence, growth hormone secretion and glucose metabolism. J. Clin. Endocr. and Meta., 32/2: 260, 1971.
• 11- Cameron, D. P. et al: Metabolic clearence rate of radioiodinated numan growth hormone. J. Clin. Invest., 48:1600, 11969.
• 12- Conn, H. O., Daughaday, W. H. Cirrhosis and diabetes; serum human growth hormone levels in Laennec's cirrhosis. J. Lab. Clin. Med., 76: 678, 1970.
• 13- Daughaday, W. H. Sulfation factor measurement and the recognition of pituitary dwarfism. J. Clin. Endocr. and Meta., 23/7: 638, 1963.
• 14- Davis, D. O.: Neuroradiological diagnosis of sellar and parasellar lesions. Clinical Neurosurgery, 17: 160, 1970.
• 15- Dillon, R. S. Handbook of Endocrinology, Lea and Febiger, 1973.
• 16- Dole, V. P.: Plasma FFA determination. J. Clin. Invest., 35: 150, 1956.
• 17- Eddy, R. L.: Human growth hormone release. A J. of Med., 56/2: 179, 1974.
• 18- Ewer, R. W., Deiss, W. P. : Clinical experience with human growth hormone; immunoassay by two antibody method. Arch. Intern. Med 124: 461, 1969.
• 19- Frasier, S. D.: The serum growth hormone response to hypoglycema in dwarfism. J. Pediatr., 71:625, 1967.
• 20- Garcia, J. F. Plasma growth hormon studies in normal individual and acromegalle patients. J. Clin Endocr, and Meta., 27/10: 1395, 1967.
• 21- Girard, J. et al. Stimulation of growth hormone secretion Schweiz Med. Wschr., 101:930, 1971
• 22- Glick, S. M., Roth, J. Yalow, R. S., Berson, S. A. : Immunoassay of human growth hormone in plasma. Nature, 199: 784, 1963.
• 23- Glick. S. M. Hypoglycemic threshold for human growth hormone release. J. Clin. Endocr, 30: 619. 1970
• 24- Greenwood, F. C. Landon, J., Stam, J. C. B. : Plasma sugar, free fatty acid, cortisol and growth hormone response to insulin in control subjects. J. Clin. Invest., 45: 429, 1966.
• 25- TTO. H. et al. Effect of prostaglandin on secretion of human growth hormone. J. Clin. Ender 32: 857, 1971
• 26- Kansal, P. C., Buse, J., Talbert, O. R., Buse, M. G. : The effect of L-DOPA on plasma growth hormone, insulin and thyroxine J. Clin Endocr. and Meta, 34/1:99, 1972.
• 27- Kaplan, S. L., et al Growth hermone changes in serum level of growth hormone following hypoglycemia in 184 children with growth retardation. Pediatr. Res. 2:43, 1968,
• 28- Karp, M. et al. Changes in blood glucose and plasma insulin, free fatty acids, growth hormone and 11-hydroxcorticoids during intramuscular vasopresain tests in children and adolesance Acta Endocr, 55515. 1968.
• 29- Kato, Y., Morimoto, M., Imura, H.: Plasma growth hormone in hyper-thyroidism and obesity: Effect of propranolol infusion. Metabolism, 19: 406, 1970,
• 30- Kleinberg, D. L., Young, I. S., Kupperman, H. S.: The sesamold index, an aid in the diagnosis of acromegaly. Ann. Intern. Med., 64: 1075, 1966.
• 31- Kowarski, A.: Determination of integrated plasma concentrations and true secretion rates of human growth hormone. J. Clin. Endocr. and Meta., 32/3: 356, 1971.
• 32- Krieger, D. T.: A comparative study of endocrine tests in hypothalamic disease circadian periodicity of plasma 11-OH and GH response to insulin hypoglycemia and metyrapone responsineness. J. Clin. Endocr. and Meta., 28/11: 1589, 1968.
• 33- Kunita, H. et al. : Effect of metyrapone on secretion of growth hormone in man. J. Clin. Endocr., 31/3: 301, 1970.
• 34- Landon, J. et al. : The plasma sugar, free fatty acids, cortisol and growth hormone response to insulin and the comparison of this procedure with other tests of pituitary and adrenal function. II. in patients with hypothalamic or pituitary dysfunction or anorexia nervosa. J. Clin. Invest., 45: 437, 1966.
• 35- Lawrence, A. M., Kirsteins, L. Progeation in the medical management of active acromegaly. J. Clin. Endocr. and Meta, 30/50646, 1970
• 36- Lee, P. A., Keenan, B. S. Effect of various ACTH preparations and of metyrapone on the secretion of growth hormone in normal subjects and in hypopituitary patients. J. Clin. Endocr. and Meta., 37/3:389, 1973.
• 37- Lin, Shu Ren and Lee, K. F. Relative value of some radiographie measurements of hand in diagnosis of acromegaly. Invest. Radiol, 6:426, 1971.
• 38- Mac Gillivary, M. H., Frohman, L. A. : Metabolic clearance and preduction rates of human growth hormone in subjects with normal and abnormal growth. J. Clin. Endocr, 30: 632, 1970.
• 39- Massara, F., Camanni, F. and Molinatti, G. M. Serum inorganic phosphorus pattern during augmented insulin tolerance test in acromegaly. J. Endocr. 34:13, 1966.
• 40- Mc Lanchian, M. S. F., Wright, A. D. : Plain film and tomographie assesment of pİyuitary fossa in 140 acromegalic patients. Brit. J. Radiol., 43:360, 1970.
• 41- Merimee, T. J. Rabinowitz, D. : Arginine - initiated release of human growth hormone New Eng. J. Med., 280 1134, 1960
• 42- Mims, R. B. et al. The effect of a single dose of L-DOPA on pituitary hormones in acromegaly, obesity and in normal subjects. J. Clin. Endocr. and Meta., 37/1:34, 1973.
• 43- Mims, R. B., Scott, C., Modebe, O. M.: Prevention of L-DOPA-induced growth hormone stimulation by hyperglycemia. Clin. Endocr. and Meta.. 37/5: 660, 1973.
• 44- Mintz, D. H.: Effect of estrogen therapy on carbohydrate metabolism In acromegaly. J. Clin. Endocr. and Meta., 27/9: 1321, 1967.
• 45- Mitchell, M. L. et al. : Detection of growth hormone deficiency, the glucagon stimulation test. New Eng. J. Med., 282: 539, 1970.
• 46- Nakagawa, K. : Effect of dexamethasone on plasma growth hormone levels in acromegaly. J. Clin. Endocr. and Meta., 31/5: 502, 1970.
• 47- Nakagawa, K. : Further studies on the relation between growth hor-mone and corticotropin secretion in insulin induced hypoglycemia. J. Clin. Endocr. and Meta., 32/2: 188, 1973.
• 48- Nakagawa, K., Mashimo, K. Suppressibility of plasma growth hormone levels in acromegaly with dexamethasone and phentolamine. J. Clin. Endocr. and Meta., 37/2: 238, 1073.
• 49- Parks, et al.: Growth hormone responses to propranolol-glucagon stimulation; a comparison with other tests of growth hormone reserve J. Clin. Indocr. and Meta., 37/185, 1973.
• 50- Pearson, N. B. Clinical Neurosurgery, 21:26, 1974.
• 51- Rakoff, J. S., Silver, T. M. : Prolactin and growth hormone release in response to sequential stimulation by arginine and synthetic TRF J. Clin. Endocr. and Meta., 37/5:641, 1973.
• 52- Rool, A. W. et al. The plasma growth hormone response to insulin induced hypoglycemia in children with retardation of growth. Pediatrics, 39: 844, 1967.
• 53- Roth, J. et al.: Hypoglycemia, a patent stimulus to secretion of growth hormone. Science, 140:987, 1963.
• 54- Salesses, A. : Le facteur de sulfatation, Rw. Fr. d'et Cl. et Biol., ХП/10: 946, 1967.
• 55- Sawin, C. T., Mitchell, M. L: Comparison of response of serum growth hormone to glucagon and vasopressin, Metabolism, 19 895, 1970.
• 56- Scwartz, E. et al. : Estrogenic antagonism of metabolic effects of administered growth hormone. J. Clin. Endocr and Meta, 20/9: 1176, 1969,
• 57- Strauch, G. et al.: Irreversible growth hormone hypersecretion in ac-romegaly. Prense Mad, 78 167, 1970.
• 58- Taylor, A. L., Finster, J. L. : Metabolic cleararce and production rates of human growth hormone. J. Clin. Invest., 48: 2349, 1969.
• 59- Van Wyk, J. J, et al. : Further purification and characterization of sulfation factor and thymidine factor from acromegalic plasma. J. Clin. Endocr. and Meta., 32/3: 389, 1971.
• 60- Werk, E., Theiss, K. E. : A fluorcmetric method for the determination of plasma cortisol. J. Clin. Endocr. and Meta., 27/9: 1350, 1967.
• 61- Wiedemann, E., Schwartz, E. : pendent human serum sulfation factor by estrogen. J. Clin. Endocr, and Meta., 84/1:51, 1972.
• 62- Wieland, R. G., Hallberg, M. C. : Growth hormone response to intramuscular glucagon. J. Clin. Endocr. and Meta. 37/2 329, 1973.