Discordance between growth hormone and insulin-like growth factor-1 after pituitary surgery for acromegaly: a stepwise approach and management.

摘要: Follow-up management of patients with acromegaly after pituitary surgery is performed by conducting biochemical assays growth hormone (GH) and insulin-like factor-1 (IGF1). Despite concordant results these two tests in the majority cases, there increasing recognition who show persistent or intermittent discordance between GH IGF1 (normal elevated vice versa). In this narrative review, last three decades materials on issue discrepancy were thoroughly assessed. Various studies have obtained different rates, ranging from 5.4 to 39.5 %. At present, despite use current sensitive more stringent criteria define remission, rate still remains high. A number mechanisms been proposed explain postoperative including; altered dynamics secretion surgery, early assay, inaccurate less laboratory errors, too high cut-off point for suppression assays, nadir values not adjusted age, sex, body mass index, influence concomitant medication, co-existing physiologic pathologic conditions, many other reasons. Nevertheless, underlying are far clear, solution continues evade complete elucidation. Similarly, impacts such a over mortality morbidity risk and/or clinical recurrence unclear. As challenging problem, stepwise evaluation appears be rational.