Michio Otsuki    Department   School of Medicine(Tokyo Women's Medical University Hospital), School of Medicine    Position   Professor and Division head
Article types	Original article
Language	English
Peer review	Peer reviewed
Title	Clinical Characteristics of Acromegalic Patients With Paradoxical GH Response to Oral Glucose Load
Journal	Formal name：The Journal of clinical endocrinology and metabolism Abbreviation：J Clin Endocrinol Metab ISSN code：0021972X/19457197
Domestic / Foregin	Foregin
Volume, Issue, Page	104(5),pp.1637-1644
Author and coauthor	Mukai, K. Otsuki, M. Tamada, D. Kitamura, T. Hayashi, R. Saiki, A. Goto, Y. Arita, H. Oshino, S. Morii, E. Saitoh, Y. Shimomura, I.
Authorship	2nd author,Corresponding author
Publication date	2019
Summary	CONTEXT: A paradoxical GH response to oral glucose (OG) is often found in acromegaly. However, the clinical characteristics of patients with acromegaly and a paradoxical GH response to OG (OG responders) remain unclear. OBJECTIVE: The aim of the present study was to define the clinical characteristics of OG responders with acromegaly. DESIGN: Retrospective study. SETTING: Hospitalized care at Osaka University Hospital. PATIENTS AND METHODS: Of 63 patients with acromegaly admitted to our hospital from January 2006 to January 2017, 19 were classified as OG responders and 44 as nonresponders. The clinical characteristics of these groups were compared. RESULTS: Before surgery, OG responders had substantially greater IGF-1 SD scores than nonresponders (P<0.05), although no difference was found in basal GH levels between the two groups (P = 0.46). Regarding glucose metabolism, 120-minute plasma glucose and immunoreactive insulin after OG administration and hemoglobin A1c were significantly greater in OG responders than in nonresponders (P<0.01, P<0.05, P<0.05, respectively). GH levels during octreotide or bromocriptine testing were decreased more significantly in OG responders than in nonresponders (P<0.05, P<0.05, respectively). The proportion of pituitary tumors with hypointensity on T2-weighted MRI was significantly greater in OG responders than in nonresponders (P<0.05). The difference in IGF-1 and parameters of glucose metabolism described disappeared between the two groups after surgery. CONCLUSIONS: The paradoxical GH response reflected the clinical characteristics, especially IGF-I level, glucose metabolism, and drug efficacy in acromegaly. A paradoxical GH response, in addition to the nadir GH levels, to OG load is potentially useful for evaluation of the clinical characteristics of acromegaly.
DOI	10.1210/jc.2018-00975
Document No.	30476255