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Submitted on October 13, 2004
Accepted on December 22, 2004
Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York; Division of Endocrinology, Diabetology and Clinical Nutrition, University Hospital Basel; Department of Neurosurgery, Mount Sinai School of Medicine, New York, New York
* To whom correspondence should be addressed. E-mail: Puderj{at}uhbs.ch.
The criteria for biochemical control of acromegaly which will best reduce disease-related morbidity in acromegaly are debated. We therefore studied the relationship of biochemical markers with an important metabolic parameter, insulin sensitivity, as well as with clinical parameters reflecting disease activity in acromegaly.
Newly diagnosed and postoperative patients with acromegaly underwent assessment of fasting IGF-I, and fasting and post-OGTT GH and insulin levels, and completed a numeric signs and symptoms questionnaire. Insulin sensitivity was estimated by the quantitative insulin sensitivity check index (QUICKI) and the composite insulin sensitivity index. Patients were divided into; Group I: normal IGF-I and nadir GH < 0.14 µg/liter (n = 21); Group II: normal IGF-I and nadir GH 
0.14 µg/liter (n = 20); Group III (active): elevated IGF-I (n = 25). Age, sex and BMI were comparable in these groups.
Insulin sensitivity was reduced in Group III (QUICKI: 0.33 ± 0.01 and composite index: 3.44 ± 0.54) compared with Group II (0.38 ± 0.01, P = 0.002 and 8.18 ± 1.21, P = 0.0008), Group I (0.38 ± 0.01, P = 0.0008 and 8.91 ± 1.34, P = 0.00001) and to healthy controls (0.37 ± 0.008, P = 0.009). When other nadir GH cut-offs were analyzed, insulin sensitivity remained relatively reduced in the elevated IGF-I group. IGF-I was a significant predictor for decreasing insulin sensitivity as calculated by QUICKI (r=0.6, P < 0.0001) independently of nadir GH. Signs and symptoms scores were higher in Group III (mean 38.5 ± 3.6%) compared with Group II (mean 23.5 ± 3.2%, P = 0.004) and to Group I (mean 20.5 ± 3.7%, P = 0.0008), but not between the latter two groups.
Our data indicate that overall, and specifically in the presence of discordant serum IGF-I and nadir GH levels, IGF-I was more predictive than GH levels of insulin sensitivity and clinical symptoms score in patients with acromegaly.
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