[Abnormal elevation of growth hormone in patients with pituitary adenoma combined with cirrhosis: A case report].

Q3 Medicine
北京大学学报(医学版) Pub Date : 2025-04-18
Yanlei Wang, Min Duan, Jianzhong Xiao, Wenhui Zhao
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引用次数: 0

Abstract

The oral glucose growth hormone suppression test is commonly used in the clinical diagnosis of acromegaly, but its results can be influenced by a variety of factors. This case report discusses a patient with a pituitary tumor and concurrent liver cirrhosis, highlighting the complexities in interpreting test results under such conditions. The patient, a 54-year-old male, presented with blurred vision as his primary complaint. Notably, the physical examination revealed no changes in facial features, no enlargement of hands or feet, and no other symptoms typically associated with acromegaly, which might otherwise suggest excessive growth hormone activity. Magnetic Resonance Imaging (MRI) of the pituitary gland indicated that the gland was within normal size parameters, but a small low-intensity lesion mea-suring approximately 3 mm×2 mm identified. This finding was consistent with a pituitary microadenoma. The patient's fasting growth hormone levels were significantly elevated at 8.470 μg/L, compared with the normal range of less than 2.47 μg/L. Conversely, fasting insulin-like growth factor-1 (IGF-1) levels were notably low, recorded at 41 and 52 μg/L, whereas the normal range for a person of his age was between 87 and 234 μg/L. Other pituitary hormones, including those regulating the thyroid, adrenal cortex, and sex hormones, were found to be within normal ranges. Despite this, during the glucose growth hormone suppression test, an abnormal elevation of growth hormone was observed. To investigate further, the patient was administered branched-chain amino acids, and the suppression test was repeated. However, the abnormal elevation of growth hormone persisted, indicating a failure to normalize the response. Given the patient's lack of clinical signs typically associated with elevated growth hormone secretion, the history of liver cirrhosis became a significant consideration. The disparity between elevated growth hormone levels and reduced IGF-1 levels suggested that the pituitary lesion was a non-functional adenoma rather than a source of excess hormone production. Consequently, it was concluded that the abnormal response of growth hormone to the glucose suppression test was likely related to the patient's liver cirrhosis. In addition to chronic liver disease, various other conditions could influence the results of the oral glucose tolerance growth hormone suppression test. According to the literature, factors such as puberty, diabetes, anorexia nervosa, and protein malnutrition could also affect test outcomes. These conditions could cause similar abnormalities in growth hormone dynamics, complicating the diagnosis. Therefore, clinicians must be vigilant and consider these potential influences when interpreting test results.For an accurate diagnosis of acromegaly, it is essential to combine clinical symptoms, detailed medical history, and imaging studies. The presence of conditions like liver cirrhosis should prompt careful interpretation of the test results, ensuring that other contributing factors are not overlooked. This comprehensive approach is crucial to avoid misdiagnosis and to ensure that appropriate treatment strategies are implemented based on a thorough understanding of the patient's overall health status.

[垂体腺瘤合并肝硬化患者生长激素异常升高1例]。
口服葡萄糖生长激素抑制试验是临床上诊断肢端肥大症常用的方法,但其结果受多种因素影响。本病例报告讨论了一位垂体瘤并发肝硬化的患者,强调了在这种情况下解释检查结果的复杂性。患者男,54岁,主诉视力模糊。值得注意的是,体格检查未发现面部特征改变,手脚未变大,也未发现与肢端肥大症相关的其他典型症状,这些症状可能提示生长激素活性过高。垂体核磁共振成像(MRI)显示腺体大小参数正常,但发现一个小的低强度病变,约为3 mm×2 mm。这一发现与垂体微腺瘤一致。患者空腹生长激素水平显著升高至8.470 μg/L,而正常范围小于2.47 μg/L。相反,空腹胰岛素样生长因子-1 (IGF-1)水平明显较低,记录为41和52 μg/L,而他这个年龄的人的正常范围是87到234 μg/L。其他垂体激素,包括调节甲状腺、肾上腺皮质和性激素的激素,都在正常范围内。尽管如此,在葡萄糖生长激素抑制试验中,观察到生长激素异常升高。为了进一步研究,患者被给予支链氨基酸,并重复抑制试验。然而,生长激素的异常升高持续存在,表明未能使反应正常化。鉴于患者缺乏与生长激素分泌升高相关的典型临床症状,肝硬化史成为一个重要的考虑因素。生长激素水平升高和IGF-1水平降低之间的差异表明垂体病变是一种非功能性腺瘤,而不是激素过量产生的来源。因此,我们认为生长激素对葡萄糖抑制试验的异常反应可能与患者的肝硬化有关。除了慢性肝病外,其他各种情况也会影响口服糖耐量生长激素抑制试验的结果。根据文献,青春期、糖尿病、神经性厌食症和蛋白质营养不良等因素也可能影响测试结果。这些情况可能导致生长激素动力学的类似异常,使诊断复杂化。因此,临床医生在解释检测结果时必须保持警惕并考虑这些潜在的影响。对于肢端肥大症的准确诊断,必须结合临床症状、详细的病史和影像学检查。出现肝硬化等情况时,应仔细解释检查结果,确保其他因素不被忽视。这种全面的方法对于避免误诊和确保基于对患者整体健康状况的全面了解实施适当的治疗策略至关重要。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
北京大学学报(医学版)
北京大学学报(医学版) Medicine-Medicine (all)
CiteScore
0.80
自引率
0.00%
发文量
9815
期刊介绍: Beijing Da Xue Xue Bao Yi Xue Ban / Journal of Peking University (Health Sciences), established in 1959, is a national academic journal sponsored by Peking University, and its former name is Journal of Beijing Medical University. The coverage of the Journal includes basic medical sciences, clinical medicine, oral medicine, surgery, public health and epidemiology, pharmacology and pharmacy. Over the last few years, the Journal has published articles and reports covering major topics in the different special issues (e.g. research on disease genome, theory of drug withdrawal, mechanism and prevention of cardiovascular and cerebrovascular diseases, stomatology, orthopaedic, public health, urology and reproductive medicine). All the topics involve latest advances in medical sciences, hot topics in specific specialties, and prevention and treatment of major diseases. The Journal has been indexed and abstracted by PubMed Central (PMC), MEDLINE/PubMed, EBSCO, Embase, Scopus, Chemical Abstracts (CA), Western Pacific Region Index Medicus (WPR), JSTChina, and almost all the Chinese sciences and technical index systems, including Chinese Science and Technology Paper Citation Database (CSTPCD), Chinese Science Citation Database (CSCD), China BioMedical Bibliographic Database (CBM), CMCI, Chinese Biological Abstracts, China National Academic Magazine Data-Base (CNKI), Wanfang Data (ChinaInfo), etc.
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