GIGANTISM AND ACROMEGALY - Diagnosis



In fully developed acromegaly the physical findings are so characteristic as to provide an un­mistakable diagnosis. Confirmation of this diag­nosis as well as determination of whether or not the disease is in an active phase requires mea­surement of growth hormone. Levels of growth hormone obtained under basal conditions gener­ally exceed the upper limit of normal (5 ng/ml) and typically cannot be suppressed by a physio­logical maneuver such as administration of glu­cose. A paradoxical increase in growth hormone levels in response to administration of glucose oc­curs in some patients with acromegaly, whereas administration of L-dopa, which normally stim­ulates growth hormone, usually reduces the lev­els. Both TRH and GnRH, which normally have no effect on growth hormone, may cause a para­doxical rise in growth hormone levels in patients with acromegaly. Measurement of plasma con­centrations of somatomedin C may also be useful, inasmuch as plasma levels of this mediator of growth hormone action fluctuate less than those of growth hormone and are thought to reflect more accurately the state of disease activity.





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