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Patterns of growth hormone response to the provocative stimuli of insulininduced hypoglycemia, arginine infusion and exercise, and to the suppressive effects of hyperglycemia were studied in acromegalic subjects in order to examine the frequency of autonomous behavior of these functioning pituitary tumors. In all but one instance, non-autonomous behavior of growth hormone secretion characterized these acromegalic subjects. Persistence of a given pattern to particular physiologic manipulations indicated that such alterations in growth hormone levels were not random secretory discharges. Non-autonomous behavior of growth hormone secretion in active acromegaly would seem to imply hypothalamic control of growth hormone secretion despite elevated levels of growth hormone in these patients. These observations and the frequency with which unusual or paradoxical growth hormone responses were obtained suggest the possibility that acromegaly may begin as a primary hypothalamic disturbance with chronically elevated and inappropriate levels of growth hormone releasing factor resulting in hypertrophy and hyperplasia of somatotrophs and, in some cases, acidophilic pituitary tumor formation.
Lawrence et al. (Tue,) studied this question.