Predictive Value of Circulating Insulin-Like Growth Factor I Levels in Ischemic Stroke Outcome
Open Access
- 1 October 2006
- journal article
- other
- Published by The Endocrine Society in Journal of Clinical Endocrinology & Metabolism
- Vol. 91 (10), 3928-3934
- https://doi.org/10.1210/jc.2006-1040
Abstract
Context: Cerebrovascular disease is highly prevalent in the general population, frequently leading to permanent invalidity and reduced quality of life. IGF-I is recognized as an important neuroprotective factor against cerebral hypoxic insult. Objective: The objective of the study was to evaluate pituitary function, in particular GH-IGF-I axis, in adult patients receiving rehabilitation after an ischemic stroke. Subjects and Methods: We studied 42 patients (12 females; age range, 50–88 yr) during rehabilitation after stroke, evaluating the relationship between the GH-IGF-I axis and the severity (National Institutes of Health stroke scale) and outcome [Rancho Los Amigos Scale of Cognitive Functioning (LCFS); Functional Independence Measure (FIM); modified Ranking Scale] from stroke. Results: GH deficiency was demonstrated in five patients (11.9%). Peak GH after GHRH + arginine test and IGF-I levels did not correlate with severity of stroke. IGF-I was positively correlated with LCFS (r = 0.305, P < 0.05) and the difference between FIM on admission and at discharge from rehabilitation (ΔFIM; r = 0.361, P < 0.02). Outcome indexes (LCFS, FIM at discharge, ΔFIM) and occurrence of favorable outcome (modified Ranking Scale 0–1) were significantly (P < 0.05) higher in patients with IGF-I levels 161.8 μg/dl or greater (50th percentile of the patient distribution). LH-FSH deficiency (three cases), ACTH deficiency (one case), and hyperprolactinemia (two cases) were detected. One patient had primary hypogonadism, and six males had low testosterone with normal LH and FSH levels. By multivariate analysis, IGF-I level was the main significant predictor of ΔFIM and LCFS. Conclusions: Ischemic stroke may be associated with pituitary dysfunction, particularly GH and gonadotropin deficiencies. The higher IGF-I levels observed in patients with better outcome suggest a possible neuroprotective role of IGF-I. Circulating IGF-I may predict functional performance during rehabilitation and ischemic stroke outcome.Keywords
This publication has 38 references indexed in Scilit:
- Insulin-like growth factor I promoter polymorphism, risk of stroke, and survival after stroke: the Rotterdam studyJournal of Neurology, Neurosurgery & Psychiatry, 2006
- Insulin-Like Growth Factor (IGF) I, -II, and IGF Binding Protein-3 and Risk of Ischemic StrokeJournal of Clinical Endocrinology & Metabolism, 2005
- Ischaemic stroke in young adults: predictors of outcome and recurrenceJournal of Neurology, Neurosurgery & Psychiatry, 2005
- Cerebral aneurysm and acromegaly: A case reportJournal of Endocrinological Investigation, 2004
- The Prospective Association of Serum Insulin-Like Growth Factor I (IGF-I) and IGF-Binding Protein-1 Levels with All Cause and Cardiovascular Disease Mortality in Older Adults: The Rancho Bernardo StudyJournal of Clinical Endocrinology & Metabolism, 2004
- Cardiovascular disease and insulin-like growth factor I.Circulation, 2002
- Low Serum Insulin-Like Growth Factor I Is Associated With Increased Risk of Ischemic Heart DiseaseCirculation, 2002
- Plasma Insulin-like Growth Factor I and IGF Binding Protein 3 Levels in Patients With Acute Cerebral Ischemic InjuryStroke, 1997
- Increased cerebrovascular mortality in patients with hypopituitarismClinical Endocrinology, 1997
- Premature mortality due to cardiovascular disease in hypopituitarismThe Lancet, 1990