How do you evaluate remission in acromegaly when postoperative IGF-1 and GH levels are discordant?

It depends how long after surgery. IGF-1 may take up to 3 months form curative surgery to normalize. If GH is low (<0.4 ng/mL) and IGF-1 is still abnormal and you are less than 3 months form surgery, I would just wait. If the opposite is true (Normal IGF-1 but elevated random GH), I would perform a ...

IGF-I has longer half-life than GH so normal IGF-I suggests remission of acromegaly in most cases, except when IGF-I may be low due to other causes. If fasting GH is high, glucose suppression can help better define GH excess, if any. One should also assess based on symptoms of acromegaly and MRI res...