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The Journal of Clinical Endocrinology & Metabolism Vol. 82, No. 10 3187-3191
Copyright © 1997 by The Endocrine Society

From the Clinical Research Centers

Pituitary Irradiation Is Ineffective in Normalizing Plasma Insulin-Like Growth Factor I in Patients with Acromegaly1

Ariel L. Barkan, Ildiko Halasz, Kenneth J. Dornfeld, Craig A. Jaffe, Roberta DeMott Friberg, William F. Chandler and Howard M. Sandler

Pituitary and Neuroendocrine Center, Division of Endocrinology and Metabolism, Department of Internal Medicine (A.L.B., I.H., C.A.J., R.D.F.), Division of Neurosurgery, Department of Surgery (W.F.C.), and Department of Radiation Oncology (H.M.S., K.J.D.), University of Michigan Medical Center, and the Department of Veterans Affairs Medical Center, Ann Arbor, Michigan 48109

Address all correspondence and requests for reprints to: Ariel Barkan, M.D., Division of Endocrinology and Metabolism, Department of Internal Medicine, 3920 Taubman Center, University of Michigan Medical Center, Ann Arbor, Michigan 48109-0354.

Pituitary irradiation suppresses GH hypersecretion in patients with acromegaly. Within 10 yr after radiotherapy, up to 80% of patients achieve plasma GH levels below 5 µg/L. Whether this is sufficient to normalize plasma insulin-like growth factor I (IGF-I) levels, is unknown. We examined the effect of radiotherapy on plasma IGF-I concentrations in patients with acromegaly.

We reviewed hospital charts of 140 patients with acromegaly seen in our institution between 1975 and 1996. Data on plasma GH and IGF-I were extracted and tabulated longitudinally together with the information about the concomitant medical therapy. We included data from the patients who received radiotherapy as a part of their treatment and whose IGF-I was monitored for more than 1 yr afterward. To avoid the potential bias, the data for patients who were referred to us for medical therapy, having failed radiation elsewhere, were excluded.

A total of 38 datasets were submitted for the final analysis. The average follow-up was 6.8 ± 0.8 yr (range, 1–19). Only 2 patients achieved age- and sex-adjusted normal IGF-I levels while off medical therapy. Noncured patients had a mean plasma GH level of 4.6 ± 1.1 µg/L but still elevated plasma IGF-I levels (219 ± 26% of the upper normal limit) at the last follow-up visit. A random GH concentration below 1.5 µg/L was associated with a pathologically high plasma IGF-I concentration in 43% of instances.

Radiotherapy appears to be ineffective in normalizing plasma IGF-I levels in acromegaly. A multicenter study to reevaluate the future use of this modality in patients with acromegaly is warranted.




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