An acromegalic patient with low Insulin-Like Growth Factor-1 levels: it may not be found to be elevated during diagnosis of acromegaly each time

Abstract

The diagnosis of acromegaly is based on demonstration of excess growth hormone (GH) and Insulin-Like Growth Factor-1 (IGF-1) secretion. IGF-1 is the most reliable biochemical indicator of activity of acromegaly. However, there are some pitfalls in the interpretation of change of plasma IGF-1 levels. We aim to report a case with acromegaly that has low IGF-1 levels and elevated GH levels associated with poorly controlled type 2 diabetes mellitus and malnutrition. A 38-years-old woman was admitted to emergency departmant due to hyperglycemia, weakness, cough, dyspnea, high fever. She has been complaining for enlargement of her hands and feet for ten years and she was cachectic for a long time. During oral glucose tolerance test (OGTT), serum growth hormone levels were found to be higher than normal range according to the matching age and sex subjects but IGF-1 and IGFBP-3 levels were measured lower than the reference range. A macroadenoma of 3x2.5 cm diameter was determined in magnetic resonance imaging of the pituitary gland. As a conclusion, determining elevated IGF-1 levels are very important for the diagnosis and activity of acromegaly, but careful interpretation of IGF-1 levels is necessary in type 2 diabetic patients with acromegaly.

Key Words: Acromegaly, IGF-1, malnutrition, type 2 diabetes mellitus.

Keywords

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Düşük Insulin-Like Growth Factor-1 düzeyleri olan bir akromegalik hasta: IGF-1 akromegali tanısında her zaman yüksek bulunmayabilir

Abstract

Akromegali tanısı aşırı GH ve Insulin-Like Growth Factor-1 (IGF-1) sekresyonunun gösterilmesine dayanır. IGF-1 akromegalinin aktivasyonunun en güvenilir göstergesidir. Bununla birlikte plazma IGF-1 düzeylerinin değişikliklerinin yorumlanmasında bazı tuzaklar vardır. Biz kötü kontrollü tip 2 diabetes mellitus ve malnütrisyon ile ilişkili olarak düşük IGF-1 ve artmış GH düzeyleri olan bir akromegalili olguyu sunmayı amaçladık. Otuz sekiz yaşındaki kadın hasta hiperglisemi, halsizlik, öksürük, dispne, yüksek ateş yakınmaları yüzünden acil servise baş vurdu. On yıldır ellerinde ve ayaklarında büyüme olmasından yakınmaktaydı ve uzun zamandır kaşektikti. OGTT sırasında serum growth hormon düzeyleri yaş ve cinsiyete göre olan normal sınırlardan yüksek bulundu. Fakat IGF 1 and IGFBP-3 normal referans aralığından düşük ölçüldü. Hipofizin manyetik rezonans görüntülemesinde 3x2.5 cm çaplı bir pituiter makroadenom saptandı. Sonuç olarak, artmış IGF-1 düzeyleri akromegali tanı ve aktivitesinde çok önemlidir, ancak tip 2 diyabetli akromegalilerde IGF-1’ in dikkatli yorumlanması gereklidir.

Anahtar Kelimeler: Akromegali, IGF-1, malnutrisyon, tip 2 diabetes mellitus

Keywords

• Akromegali, IGF-1, malnutrisyon, tip 2 diabetes mellitus

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29. Duncan E, Wass JA. Investigation protocol: acromegaly and its investigation. Clin Endocrinol (Oxf) 1999:50;285-93.
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