, Volume 59, Issue 3, pp 634–642 | Cite as

Elevated serum IGF-1 level enhances retinal and choroidal thickness in untreated acromegaly patients

  • Xia Zhang
  • Jin Ma
  • Yuhan Wang
  • Lüe Li
  • Lu Gao
  • Xiaopeng Guo
  • Bing XingEmail author
  • Yong ZhongEmail author
Original Article



1) To compare the retinal, choroidal, Haller’s layer, and Sattler’s/choriocapillaris thicknesses of untreated acromegaly patients without chiasm compression or diabetes mellitus and healthy controls. 2) To evaluate the correlations of retinal and choroidal thicknesses with serum growth hormone (GH) and insulin-like growth factor 1 (IGF) burden.


This prospective, case-control study included 27 untreated acromegaly patients and 27 sex-matched and age-matched controls. Subfoveal choroidal, Haller’s layer and Sattler’s/choriocapillaris thicknesses were determined by enhanced-depth imaging optical coherence tomography (EDI-OCT). Foveal and macular retinal thicknesses were determined with SD-OCT. GH and IGF-1 burdens were defined as the product of disease duration and treatment-naïve serum GH and IGF-1 levels.


Compared with healthy controls, patients with acromegaly exhibited significantly increased foveal retinal (p = 0.003), subfoveal choroidal (p < 0.001), and Haller’s layer (p < 0.001) thicknesses, with no differences in Sattler’s/choriocapillaris layer thickness. Multiple point measurements in the posterior pole area showed equally increased nasal and temporal parts of the choroid. The retinal thickness maps of the two groups did not significantly differ. Correlation analysis indicated that choroidal thickness was significantly correlated with disease duration (p = 0.01), serum IGF-1 level (p = 0.03) and IGF-1 burden (p = 0.009). No significant correlations were detected between choroidal thickness and GH burden (p = 0.44). Retinal thickness was not significantly correlated with any factor.


The choroidal thickness of acromegaly patients was greater than that of healthy controls and was significantly correlated with disease duration, IGF-1 level and IGF-1 burden, indicating that excessive serum IGF-1 and its exposure time have a combined effect on choroidal thickness.


Acromegaly Choroidal thickness Retinal thickness IGF-1 



The authors thank Dr. Erqian Wang for her kind help and advice regarding this article.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

12020_2017_1511_MOESM1_ESM.docx (36 kb)
Supplementary Table


  1. 1.
    S. Melmed, Medical progress: acromegaly. N. Engl. J. Med. 355, 2558–2573 (2006)CrossRefGoogle Scholar
  2. 2.
    H. Altinkaynak, N. Duru, R. Ersoy et al., Topographic and biomechanical evaluation of cornea in patients with acromegaly. Cornea 34, 65–70 (2015)CrossRefGoogle Scholar
  3. 3.
    I. Cosemans, P. Demaerel, B. Wets, B. De Hauwere, W. Spileers, [Retinitis pigmentosa in association with acromegaly: a case report]. Doc. Ophthalmol. 98, 175–181 (1999)CrossRefGoogle Scholar
  4. 4.
    A. Zafar, D.R. Jordan, Enlarged extraocular muscles as the presenting feature of acromegaly. Ophthal. Plast. Reconstr. Surg. 20, 334–336 (2004)CrossRefGoogle Scholar
  5. 5.
    G. Pekel, F. Akin, M.S. Ertürk et al., Chorio-retinal thickness measurements in patients with acromegaly. Eye 28, 1350–1354 (2014)CrossRefGoogle Scholar
  6. 6.
    M. Şahin, A. Şahin, F. Kılınç et al., Retina ganglion cell/inner plexiform layer and peripapillary nerve fiber layer thickness in patients with acromegaly. Int. Ophthalmol 37, 591–598 (2017). Scholar
  7. 7.
    C.N. Jayasena, A.N. Comninos, H. Clarke, M. Donaldson, K. Meeran, W.S. Dhillo, The effects of long-term growth hormone and insulin-like growth factor-1 exposure on the development of cardiovascular, cerebrovascular and metabolic co-morbidities in treated patients with acromegaly. Clin. Endocrinol. 75, 220–225 (2011)CrossRefGoogle Scholar
  8. 8.
    A. Ozkok, E. Hatipoglu, N. Tamcelik et al., Corneal biomechanical properties of patients with acromegaly. Br. J. Ophthalmol. 98, 651–657 (2014)CrossRefGoogle Scholar
  9. 9.
    L. Katznelson, E.R. Laws Jr, S. Melmed et al., Acromegaly: an endocrine society clinical practice guideline. J. Clin. Endocrinol. Metab. 99, 3933–3951 (2014)CrossRefGoogle Scholar
  10. 10.
    American Diabetes Association, Diagnosis and classification of diabetes mellitus. Diabetes Care 36(Suppl 1), S67–S74 (2013)CrossRefGoogle Scholar
  11. 11.
    L.A. Branchini, M. Adhi, C.V. Regatieri et al., Analysis of choroidal morphologic features and vasculature in healthy eyes using spectral-domain optical coherence tomography. Ophthalmology 120, 1901–1908 (2013)CrossRefGoogle Scholar
  12. 12.
    C. Kanaka-Gantenbein, C. Kogia, M.B. Abdel-Naser, G.P. Chrousos, Skin manifestations of growth hormone-induced diseases. Rev. Endocr. Metab. Disord. 17, 259–267 (2016)CrossRefGoogle Scholar
  13. 13.
    A. Abreu, A.P. Tovar, R. Castellanos et al., Challenges in the diagnosis and management of acromegaly: a focus on comorbidities. Pituitary 19, 448–457 (2016)CrossRefGoogle Scholar
  14. 14.
    S. Tuzcu, S.A. Durmaz, A. Carlıoğlu et al., [The effects of high serum growth hormone and IGF-1 levels on bone mineral density in acromegaly]. Z. Rheumatol 76, 716–722 (2017)CrossRefGoogle Scholar
  15. 15.
    X. Guo, L. Gao, S. Zhang et al., Cardiovascular system changes and related risk factors in acromegaly patients: a case-control study. Int. J. Endocrinol. 2015, 573643 (2015)Google Scholar
  16. 16.
    L.E.H. Smith, W. Shen, C. Perruzzi et al., Regulation of vascular endothelial growth factor-dependent retinal neovascularization by insulin-like growth factor-1 receptor. Nat. Med. 5, 1390–1395 (1999)CrossRefGoogle Scholar
  17. 17.
    J. Lowe, J. Araujo, J. Yang et al., Ranibizumab inhibits multiple forms of biologically active vascular endothelial growth factor in vitro and in vivo. Exp. Eye. Res. 85, 425–430 (2007)CrossRefGoogle Scholar
  18. 18.
    R.S. Punglia, M. Lu, J. Hsu et al., Regulation of vascular endothelial growth factor expression by insulin-like growth factor I. Diabetes 46, 1619–1626 (1997)CrossRefGoogle Scholar
  19. 19.
    H. Yokouchi, T. Baba, S. Misawa et al., Changes in subfoveal choroidal thickness and reduction of serum levels of vascular endothelial growth factor in patients with POEMS syndrome. Br. J. Ophthalmol. 100, 897–901 (2016)CrossRefGoogle Scholar
  20. 20.
    H. Koizumi, M. Kano, A. Yamamoto et al., Subfoveal choroidal thickness during Aflibercept therapy for neovascular age-related macular degeneration: twelve-month results. Ophthalmology 123, 617–624 (2016)CrossRefGoogle Scholar
  21. 21.
    S.J. Ahn, K.H. Park, S.J. Woo, Subfoveal choroidal thickness changes following anti-vascular endothelial growth factor therapy in myopic choroidal neovascularization. Invest. Ophthalmol. Vis. Sci. 56, 5794–5800 (2015)CrossRefGoogle Scholar
  22. 22.
    P. Maison, P. Démolis, J. Young, G. Schaison, J.F. Giudicelli, P. Chanson, Vascular reactivity in acromegalic patients: preliminary evidence for regional endothelial dysfunction and increased sympathetic vasoconstriction. Clin. Endocrinol. (Oxf.). 53, 445–451 (2000)CrossRefGoogle Scholar
  23. 23.
    D. Chemla, P. Attal, L. Maione et al., Impact of successful treatment of acromegaly on overnight heart rate variability and sleep apnea. J. Clin. Endocrinol. Metab. 99, 2925–2931 (2014)CrossRefGoogle Scholar
  24. 24.
    Y.R. Chung, J.W. Kim, S.W. Kim, K. Lee, Choroidal thickness in patients with central serous chorioretinopathy: assessment of haller and Sattler layers. Retina 36, 1652–1657 (2016)CrossRefGoogle Scholar
  25. 25.
    C.W. Spraul, A. Baldysiak-Figiel, G.K. Lang, G.E. Lang, Octreotide inhibits growth factor-induced bovine choriocapillary endothelial cells in vitro. Graefes. Arch. Clin. Exp. Ophthalmol. 240, 227–231 (2002)CrossRefGoogle Scholar
  26. 26.
    A.J. Fischer, M.A. Scott, E.R. Ritchey, P. Sherwood, Mitogen-activated protein kinase-signaling regulates the ability of Müller glia to proliferate and protect retinal neurons against excitotoxicity. Glia 57, 1538–1552 (2009)CrossRefGoogle Scholar
  27. 27.
    A.J. Fischer, B.D. Dierks, T.A. Reh, Exogenous growth factors induce the production of ganglion cells at the retinal margin. Development 129, 2283–2291 (2002)PubMedGoogle Scholar
  28. 28.
    S. Kumar, R.N. Yadav, P. Gupta et al., Prostatic hyperplasia in acromegaly, a myth or reality: a case-control study. Eur. J. Endocrinol. 172, 97–106 (2015)CrossRefGoogle Scholar
  29. 29.
    I. Laíns, K.E. Talcott, A.R. Santos, et al., Choroidal thickness in diabetic retinopathy assessed with swept-source optical coherence tomography. Retina 38, 173–182 (2018). Scholar
  30. 30.
    A. Akashi, A. Kanamori, K. Ueda et al., The detection of macular analysis by SD-OCT for optic chiasmal compression neuropathy and nasotemporal overlap. Invest. Ophthalmol. Vis. Sci. 55, 4667 (2014)CrossRefGoogle Scholar
  31. 31.
    I. Maruko, T. Iida, Y. Sugano, A. Ojima, T. Sekiryu, Subfoveal choroidal thickness in fellow eyes of patients with central serous chorioretinopathy. Retina 31, 1603–1608 (2011)CrossRefGoogle Scholar
  32. 32.
    A.C. Lambooij, K.H. van Wely, D.J. Lindenbergh-Kortleve, R.W. Kuijpers, M. Kliffen, C.M. Mooy, Insulin-like growth factor-I and its receptor in neovascular age-related macular degeneration. Invest. Ophthalmol. Vis. Sci. 44, 2192–2198 (2003)CrossRefGoogle Scholar
  33. 33.
    I. Ocrant, K.L. Valentino, M.G. King, T.H. Wimpy, R.G. Rosenfeld, D.G. Baskin, Localization and structural characterization of insulin- like growth factor receptors in mammalian retina. Endocrinology 125, 2407–2413 (1989)CrossRefGoogle Scholar
  34. 34.
    M. Grant, G.L. King, IGF-I and blood vessels: implications for microvascular and macrovascular disease. Diabetes Rev. 3, 113–128 (1995)Google Scholar
  35. 35.
    C.W. Spraul, C. Kaven, J. Amann, G.K. Lang, G.E. Lang, Effect of insulin-like growth factors 1 and 2, and glucose on the migration and proliferation of bovine retinal pigment epithelial cells in vitro. Ophthal Res. 32, 244–248 (2000)CrossRefGoogle Scholar

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© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Ophthalmology, Peking Union Medical College HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
  2. 2.Department of Neurosurgery, Peking Union Medical College HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina

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