Clinical experiences and success rates of acromegaly treatment: the single center results of 62 patients

Abstract

BackgroundThis study aimed to report the clinical and outcome data from a large cohort of patients diagnosed with acromegaly and treated at our institution over a 20-year period.MethodsSixty-two acromegaly patients (32 women and 30 men) treated and monitored at the endocrinology polyclinic between 1984 and 2013 were enrolled in this retrospective study. Clinical features and patients’ treatment outcomes were evaluated. A level of growth hormone (GH) of <2.5 ng/ml was considered as the criterion for remission, and the normal insulin-like growth factor (IGF) range was based on gender and age.ResultsThe mean age at the time of diagnosis was 38.8 ± 1.4 years, the time to diagnosis was 4.5 ± 0.3 years, and the follow-up duration was 7.3 ± 0.8 years. Among patients’ symptoms, growth in hands and feet and typical facial dysmorphism were the most prominent (92%). The number of patients with diabetes mellitus, hypertension and hyperprolactinemia were 22 (35%), 13 (21%) and 13 (21%), respectively. Microadenomas and macroadenomas were found in eight and 54 patients, respectively. A significant correlation was found between the initial tumor diameters and GH levels (p = 0.002). The mean GH and IGF-1 levels were 39.18 ± 6.1 ng/ml and 993.5 ± 79 ng/ml, respectively. Visual field defect was found in 16 patients (32%). Thirty-one patients were treated by transsphenoidal surgery. Four of these were cured, 10 patients developed postoperative anterior pituitary hormone deficiency, and one patient developed diabetes insipidus. Twenty patients were treated by transcranial surgery, of which two were cured, while 17 patients developed postoperative anterior pituitary hormone deficiency. In total, five of the patients who were not cured after surgery were given conventional radiotherapy, of which two were cured. Four of 15 patients, on whom Gamma Knife radiosurgery was performed, were cured. Biochemical remission was achieved in 32 of 52 patients who received octreotide treatment, and in two of five patients who received lanreotide treatment.ConclusionsThe rate of surgical success in our patients was found to be low. This could be explained by an absence of experienced pituitary surgical centers or surgeons in our region, and the fact that most patients presented late at the macroadenoma stage.

Acromegaly: a Clinical Perspective

“…Macroadenomas predominated in our cohort (82.2%) with associated CS invasion or OC compression, consistent with existing literature [4,5,9,10].…”

Surgery for acromegaly

“…[14][15][16][17][18] This has also been an important factor for minimizing complications in the survey conducted on transsphenoidal surgery by Ivan Ciric. [19] More recently, there has been an emphasis on developing centers of excellence for better training of younger neurosurgeons.…”

Characteristics and outcome of surgically treated acromegaly patients attending an endocrinology clinic at a tertiary referral centre in Durban, South Africa over a period of 10 years

“…19 Other reports, such as the study of Mehtap et al from Turkey, have used less stringent criteria for cure (random GH < 2.5 μg/l and nadir GH in GTT < 1.0 μg/l). 18 The Cape Town study defined cure as random GH < 5 mU/l (1.7 μg/l), nadir GH in GTT < 2.0 mU/l (0.7 μg/l) and mean GH in GTT < 5 mU/l (1.7 μg/l).…”

“…11 In the Mehtap study the cure rate after surgery and radiotherapy was 19.3%. 18 In the USA and Europe the cure rate was 57% and 60% respectively. 16,20 In the German and Spanish Register studies, disease control, defined as a normal IGF-1, was substantially higher than in the current study (71.9% and 76% respectively).…”

“…Adjunctive medical therapy is reported to be required in 83.9% of patients in other studies and conventional radiotherapy has been used in up to 60% of subjects in other centres. 18 In the Cape Town study adjuvant therapy was confined to radiotherapy as dopamine agonists and somatostatin analogues were not available for use at that time. 11 Definitions of cure of acromegaly have changed over time, related to improved assay sensitivity and improved treatment modalities.…”