Acromegaly: a clinical perspective

Abstract

Background: To examine the clinical and hormonal profiles, comorbidities, treatment patterns, surgical pathology and clinical outcomes of patients diagnosed with acromegaly at the Cleveland Clinic over a 15-year period. Methods: A retrospective chart review of patients with acromegaly who underwent surgical resection between 2003 and 2018. Results: A total of 136 patients (62 men; mean age 48.1 years) with biochemical evidence of acromegaly were analyzed. Median insulin-like growth factor 1 (IGF-1) level at diagnosis was 769.0 ng/mL and most patients had a macroadenoma (82.2%). Immunoreactivity to growth hormone (GH) was noted in 124 adenomas, with co-staining in 89 adenomas. Complete visible tumor resection during initial surgery was achieved in 87 patients (64.0%). In this cohort, complete response to surgery alone was observed in 61 patients (70.1%), while 31 out of 65 patients (47.7%) who received additional post-surgical medications and/or radiation therapy achieved complete response. At most recent follow-up, 92 patients achieved eventual complete response by documented normalization of IGF-1 levels. Higher IGF-1 level at diagnosis (P = 0.024) and cavernous sinus invasion (P = 0.028) were predictors for failure to respond to surgery. Conclusion: In this study, the majority of tumors were macroadenoma, plurihormonal, and treated effectively with surgery alone or surgery with adjuvant medical or radiation therapy. More studies are needed to identify additional molecular biomarkers, tumor characteristics and imaging findings to individualize treatment and better predict treatment outcomes.

Recognizing the Diverse Clinical Presentations of Acromegaly: Insight from a Case Series

“…It is the secretory adenoma that produces excessive anterior pituitary hormones. 8,11 The excess growth hormone produced from it with or without over-secretion of other anterior pituitary hormones, leads to acromegaly. 6,12 Both secretory and non-secretory varieties of adenoma may cause compression over surrounding structures, especially the optic chiasma due to its anatomical proximity to the gland.…”

Immunohistochemical evaluation of biomarkers with predictive role in acromegaly: a literature review

“…Following biochemical diagnosis, a pituitary magnetic resonance imaging (MRI) will be recommended to detect the tumor and proceed with surgical treatment, usually done through a transsphenoidal approach. Primary surgical treatment remains the standard of care first-line therapy despite the recent advances done in pharmacological therapy [ 8 , 9 ]. Despite this, the final rate of success of surgical treatment remains unsatisfactory and varies widely depending on the center’s expertise, with remission rates of 30–70% being reported in various studies from different countries registries, usually lower in developed countries and for patients with less invasive tumors or microadenomas [ 10 , 11 , 12 , 13 ].…”

Insulin Like Growth Factor Binding Protein 7 as a Novel Diagnostic Marker in Sera of Iraqi Patients with Acromegaly

“…Acromegaly is characterized by excessive growth hormone (GH) release, which is usually induced by a pituitary adenoma, as well as an excess of Insulin like growth factor1(IGF-1) 1 .Circulating IGF-1 reduces GH secretion both directly and indirectly by promoting hypothalamic somatostatin secretion in the pituitary. IGF-1 has a variety of systemic, autocrine, and paracrine actions, each of which is unique to the tissues, cellular pathways, and metabolic conditions in which it occurs.…”