First but not second postoperative day growth hormone assessments as early predictive tests for long-term acromegaly persistence

Abstract

Purpose: Postoperative assessment of acromegaly activity is typically performed at least 3 months after neurosurgery (NS). Few studies have evaluated the use of early postoperative growth hormone (GH) levels as a test to predict short- and long-term remission of acromegaly. Our objective was to evaluate the diagnostic performance of serum random GH on a postoperative day one (D1-rGH) and two (D2-rGH), particularly in predicting long-term disease persistence.

Materials and methods: Forty-one subjects with acromegaly who were undergoing NS were enrolled (mean age ± SD 47.4 ± 13.1 years at diagnosis; women 54%; macroadenomas 71%). The final assessment of disease activity was performed one year after NS. ROC curves were used to evaluate the diagnostic performance of D1-rGH and D2-rGH.

Results: After a 1-year follow-up, the overall remission rate was 55%. ROC analysis identified an optimal D1-rGH cut-off value of 2.1 ng/mL for diagnosing long-term disease persistence (55.6% SE; 90.9% SP). The cut-off point became 2.5 ng/mL after maximizing specificity for disease persistence (yielding a 100% positive predictive value) and 0.3 ng/mL after maximizing sensitivity for disease remission. The optimal D2-rGH cut-off value was 0.6 ng/mL (81.8% SE; 50% SP); the cut-off point became 2.9 ng/mL after maximizing specificity and 0.1 ng/mL after maximizing sensitivity, with no clinical utility.

Conclusions: D1-rGH could be a highly specific test for the early diagnosis of long-term acromegaly persistence, which is predicted by a value > 2.5 ng/mL with a great degree of certainty. The diagnostic performance of D2-rGH was insufficient. Further research is required to validate these preliminary results prior to modifying the postoperative management of acromegaly.

Keywords: Acromegaly; Disease persistence; Early prediction; Growth hormone.

Fig. 1

ROC curves showing different cut-off values for random GH on postoperative day one (D1-rGH) for the early prediction of acromegaly persistence 1 year after neurosurgery. a Cut-off: 2.5 ng/mL; 44.4% SE; 100% SP; AUC 0.783. b Cut-off: 2.1 ng/mL, 55.6% SE; 90.9% SP; AUC 0.783. c Cut-off: 0.3 ng/mL; 100% SE; 0% SP; AUC 0.783. SE Sensitivity, SP Specificity

Fig. 2

ROC curves showing different cut-off values for random GH on postoperative day two (D2-rGH) for the early prediction of acromegaly persistence 1 year after neurosurgery. a Cut-off: 2.9 ng/mL; SE 18.2%; SP 100%; AUC 0.614. b Cut-off: 0.6 ng/mL; SE 81.8%; SP 50%; AUC 0.614. c Cut-off: 0.1 ng/mL; SE 100%; SP 22.2%; AUC 0.614. SE Sensitivity, SP Specificity