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

Öz

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.

Anahtar Kelimeler

• -

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

Öz

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

Anahtar Kelimeler

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

Kaynakça

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23. mical markers of the insulin-like growth factor(IGF) family in diagnosing
24. growth hormone excess and deficiency in adults. J Clin Endocrinol Metab 2001;86:3001-8.
25. LeRoith D, Clemmons D, Nissley P, Rechler MM. NIH conference. Insulin-like growth factors in health and disease. Ann Intern Med 1992:116;854-62.
26. Melmed S, Ho K, Klibanski A, Reichlin S, Thorner M. Recent advances in pathogenesis, diagnosis, and management of acromegaly. J Clin Endocrinol Metab 1995:80;3395-402.
27. Bahauddin MH, Rosenzweig JL, Fenstermaker R, Salazar R, Me-Bride CE, Selman W. Value of growth hormone dynamics and somatomedin-C (in. sulin-like growth factor I) levels in predicting the long term benefit after transsphenoidal surgery. J Lab Clin Med 1987:109;.346-54.
28. Freda PU. Pitfalls in the biochemical assessment of acromegaly. Pituitary 2003:6;135-40.
29. Duncan E, Wass JA. Investigation protocol: acromegaly and its investigation. Clin Endocrinol (Oxf) 1999:50;285-93.
30. Strasburger CJ, Bidlingmaier M, Wu Z, Morrison KM. Normal values of insulin-like growth factor I and their clinical utility in adults. Horm Res 2001:55;100-5.
31. van den Berghe G. Growth hormone secretagogues in critical illness. Horm Res 1999:51;21-8.
32. Miyakawa M, Hizuka N, Takano K, et al Radioimmunoassay for insulin-like growth factor I (IGF-I) using biosynthetic IGF-I. Endocrinol Jpn 1986:33;795- 801.
33. Clemmons DR, Klibanski A, Underwood LE, et al Reduction of plasma im- munoreactive somatomedin C during fasting in humans. J Clin Endocrinol Metab 1981:53;1247-50.
34. Clemmons DR, Underwood LE. Nutritional regulation of IGF-I and IGF bin- ding proteins. Annu Rev Nutr 1991:11;393-412.
35. Ketelslegers JM, Maiter D, Maes M, Underwood LE, Thissen JP. Nutritional regulation of insulin-like growth factor-I. Metabolism 1995:44;50-7.