Clinical presentation and management of acromegaly in elderly patients

Ceccato, Filippo; Barbot, Mattia; Lizzul, Laura; Cuccarollo, Angela; Selmin, Elisa; Boschin, Isabella Merante; Daniele, Andrea; Saller, Alois; Occhi, Gianluca; Regazzo, Daniela; Scaroni, Carla

doi:10.1007/s42000-020-00235-5

Cited by 17 publications

(22 citation statements)

References 47 publications

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“…A possible explanation could be the more aggressive course of the disease in younger patients than the older ones. A recently published retrospective analysis of 96 patients with acromegaly found similar differences; the authors suggested different acromegaly phenotypes: one in young patients who respond poorly to medical treatment and the other in older patients who respond well to medical therapy ( 14 ).…”

Section: Discussionmentioning

confidence: 90%

The Effect of 6 Months’ Treatment With Pasireotide LAR on Glucose Metabolism in Patients With Resistant Acromegaly in Real-World Clinical Settings

Witek

Bolanowski

Szamotulska³

et al. 2021

Front. Endocrinol.

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ObjectiveThe aim of the study was to evaluate glucose metabolism, as measured by glycated hemoglobin (HbA1c) levels and the need for antidiabetic medical treatment, in patients with acromegaly resistant to first-generation somatostatin receptors ligands (SRLs) treated with pasireotide long-acting release (LAR) in real-world clinical practice. Biochemical control of acromegaly, as measured by growth hormone (GH) and insulin-like growth factor 1 (IGF-1) levels, was also assessed.Study DesignTwo-center retrospective cohort of consecutive patients with acromegaly treated with first-generation SRLs at maximum doses, who had not achieved biochemical disease control. After SRLs were discontinued, patients were given pasireotide LAR 40 mg i.m. every 28 days. The dose was increased to 60 mg i.m. in patients for whom adequate control was not achieved after 3 months. Patients were given dietary and lifestyle advice, and antihyperglycemic treatment was modified as needed.Main Outcome MeasuresBiochemical disease control parameters (GH and IGF-1 concentration), as well as HbA1c level at baseline and after 6 months.ResultsIn total, 39 patients with acromegaly were enrolled. GH concentration decreased (Δme =-1.56 µg/L, range -21.38–3.62, p <0.001) during 6 months of pasireotide LAR treatment. A worsening of metabolic status was observed, with an increase of median HbA1c (Δme =0.40%, range -0.20%–2.30%, p <0.001), and antihyperglycemic treatment intensification in 23 (59.0%) patients. The median decline in IGF-1 concentration was: -283.0 µg/L, range -682.7–171.6, p <0.001. IGF-1 reached the age- and gender-specific upper level of normal in 23 (59%) patients.ConclusionsPasireotide LAR is an effective therapeutic option in patients with acromegaly refractory to first-generation SRLs. However, this therapy may result in pasireotide LAR-associated hyperglycemia, which requires early and aggressive antidiabetic medical therapy to prevent glucose homeostasis alterations.

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Section: Discussionmentioning

confidence: 90%

The Effect of 6 Months’ Treatment With Pasireotide LAR on Glucose Metabolism in Patients With Resistant Acromegaly in Real-World Clinical Settings

Witek

Bolanowski

Szamotulska³

et al. 2021

Front. Endocrinol.

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“…Reports of using octreotide beyond 9 years are not available (9), our patient is substantially older than other reported cases (10).…”

Section: Discussionmentioning

confidence: 59%

Advanced acromegaly: successful disease control for more than 16 years using octreotide LA

Elshafie

Woodhouse

2020

Endocrinology, Diabetes &Amp; Metabolism Case Reports

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Summary A 79-year-old male presented with a 10-year history of intermittent headache, sweating, persistent hand numbness and uncontrolled hypertension. He was receiving Nifedipine and Hydrochorothizide. On examination (O/E), his BP was 180/100 he was acromegalic. His growth hormone (GH) was 10 mIU/L (0.0–0.1) and his insulin-like growth factor (IGF-1): 952 µg/L (76–160). An MRI of the pituitary revealed a 3 × 2 cm pituitary macroadenoma. Surgery was refused and the family agreed for a therapeutic trial of octreotide. His GH levels fell immediately. Two weeks later he was switched to long-acting monthly octreotide in September 2003. During his 16-year follow-up, he has remained well and asymptomatic off medications for hypertension. His BP and IGF-1 levels were also normal until octreotide Long acting (LA) octrotide was stopped for 3 months at age 96. During this period the IGF-1 level returned to pretreatment levels 500 ng/L (50–141), GH 24 mIU/L (0.0–0.1), and a small residual tumour 0.5–0.8 cm was seen on the MRI. Octreotide LA was restarted and the IGF-1 and GH levels returned to normal. He continues the same treatment to date age 97 without side effects. We conclude that the successful control of IGF-1, GH levels, hypertension, tumour size and clinical symptoms for more than 16 years occurred using octreotide LA in an elderly advanced acromegalic patient. To the best of our knowledge, this is the first report of the successful use of octreotide LA for more than 16 years. Learning points: The value of a therapeutic trial of octreotide to identify responders. Control of GH and IGF-1 secretion using octreotide LA. The report of the successful use of octreotide for more than 16 years irrespective of age.

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“…However increased screening frequency may be a confounding factor because cancer-specific mortality rates were not increased ( 375 ). Excess mortality due to cancer may therefore be more closely linked to increased life expectancy in acromegaly rather than GH/IGF-1 excess per se ( 376 ).…”

Section: Long-term Comorbidities and Mortality Outcomesmentioning

confidence: 99%

Clinical Biology of the Pituitary Adenoma

et al. 2022

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All endocrine glands are susceptible to neoplastic growth, yet the health consequences of these neoplasms differ between endocrine tissues. Pituitary neoplasms are highly prevalent and overwhelmingly benign, exhibiting a spectrum of diverse behaviors and impact on health. To understand the clinical biology of these common yet often innocuous neoplasms, we review pituitary physiology, and adenoma epidemiology, pathophysiology, behavior, and clinical consequences. The anterior pituitary develops in response to a range of complex brain signals integrating with intrinsic ectodermal cell transcriptional events that together determine gland growth, cell type differentiation, and hormonal production, in turn maintaining optimal endocrine health. Pituitary adenomas occur in ten percent of the population; however, the overwhelming majority remain harmless during life. Triggered by somatic or germline mutations, disease-causing adenomas manifest pathogenic mechanisms that disrupt intra-pituitary signaling to promote benign cell proliferation associated with chromosomal instability. Cellular senescence acts as a mechanistic buffer protecting against malignant transformation, an extremely rare event. It is estimated that fewer than one thousandth of all pituitary adenomas cause clinically significant disease. Adenomas variably and adversely affect morbidity and mortality depending on cell type, hormone secretory activity, and growth behavior. For most clinically apparent adenomas, multimodal therapy controlling hormone secretion and adenoma growth lead to improved quality of life and normalized mortality. The clinical biology of pituitary adenomas and particularly their benign nature stands in marked contrast to other tumors of the endocrine system such as thyroid and neuroendocrine tumors.

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Clinical presentation and management of acromegaly in elderly patients

Cited by 17 publications

References 47 publications

The Effect of 6 Months’ Treatment With Pasireotide LAR on Glucose Metabolism in Patients With Resistant Acromegaly in Real-World Clinical Settings

The Effect of 6 Months’ Treatment With Pasireotide LAR on Glucose Metabolism in Patients With Resistant Acromegaly in Real-World Clinical Settings

Advanced acromegaly: successful disease control for more than 16 years using octreotide LA

Clinical Biology of the Pituitary Adenoma

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