Growth Hormone Assay-Adjusted Standardization Reveals Distinct Clinical Phenotypes in Acromegaly
Authors' conclusion
GH standardization to assay-specific ULN reveals clinically meaningful phenotypes in acromegaly that correlate with age, tumor characteristics, and disease severity (particularly arthropathy). GHxULN complements IGF-1 by capturing tumor secretory activity, and this stratification approach may support more individualized clinical decision-making.
Study context
- Population
- Patients diagnosed with acromegaly from 2010 onward, multicenter
- Participants
- 416 patients
- Exposure
- Growth hormone (GH) categories standardized to assay-specific ULN
- Outcome
- Clinical phenotypes by GH standardization and cluster analysis
Methodological detailsmulticenter, unsupervised machine learning cluster analysis
- Multicenter
- Unsupervised machine learning cluster analysis
Main finding
As reported in the abstract
- GH within normal reference range for assay (GH-B <1.0×ULN)
- 36%
- Gradient across GH-4 categories: age
- z = −5.34, P < .001
- Gradient across GH-4 categories: tumor size
- z = 8.01, P < .001
- Gradient across GH-4 categories: IGF-1
- z = 9.00, P < .001
- Gradient across GH-4 categories: symptom duration
- z = 4.34, P < .001
- Cluster 1 (older age, lower GH/IGF-1, intermediate tumor size)
- 49.0%
- Cluster 2 (intermediate age, moderate biochemical activity, smaller tumors)
- 44.4%
- Cluster 3 (younger age, markedly elevated GH/IGF-1, large aggressive tumors)
- 6.6%
Observational data: associations, not effects.
Further findings
| Outcome | OR | P value |
|---|---|---|
| ArthropathyGH 1.0-9.9×ULN vs GH <0.25×ULN · reference category not stated | 3.5 | P = 0.015 |
| ArthropathyGH ≥10×ULN vs GH <0.25×ULN · reference category not stated | 6.58 | P = 0.002 |
Microadenomas
- Microadenomas; more frequent in older patients, associated with lower GH/IGF-1
- 23.1%
Original publication
Growth Hormone Assay-Adjusted Standardization Reveals Distinct Clinical Phenotypes in Acromegaly. Endocr Pract. Published 14 October 2025. doi:10.
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