Long-term follow-up of five untreated acromegalic patients

Abstract

The present study describes the clinical, biochemical and radiological follow-up of 5 patients with acromegaly, selected from a group of 53 patients, who did not receive treatment during a follow-up period of 5\ p=n-\ 16 years. The characteristics of these patients included: 1) older age (4 cases), 2) a long history of mild symptoms and signs (4 cases), 3) absence of diabetes mellitus (5 cases), 4) relatively low plasma GH levels (3 cases).The following observations were made during follow-up: 1) clinical activity remained constant in 3 patients and lessonned in 2 patients, 2) the lateral fossa area as calculated from a plain lateral X-ray of the skull remained constant and 3) plasma GH levels measured during an oral glucose tolerance test remained constant in 3 cases, decreased substantially in one case and reached low levels in another case. In this last patient a reproducible increase of plasma GH was found after oral administration of a single dose of 2.5 mg bromocriptine, suggesting complete normality of GH secretion. It is concluded that acromegaly not necessarily progresses in all patients. The results re-emphasize the importance of taking the spontaneous course of pituitary adenomas into account when assessing the effect of various treatment protocols.The syndrome of acromegaly was first described as a clinical entity by Marie (1886). Its clinical fea¬ tures, presentation and complications are well do¬ cumented. However, the natural history of the disorder is not accurately known. A reduced life expectancy has been reported by Wright et al. (1970) who analyzed the causes of death in 55 of a group of 194 acromegalie patients from five separate hospitals and by Alexander et al. (1980) who analyzed the causes of death in 45 of a group of 164 acromegalics who were detected in a commu¬ nity survey of a population of 3.1 million over a period of 12 years. In both studies overall mortality rates were higher in untreated than in treated patients. Basal GH levels are positively correlated with the size of the pituitary tumour and young acromegalie patients generally have more rapidly growing and larger tumours at the time of diag¬ nosis than older patients (Melmed et al. 1983;Jadresic et al. 1982).In the present study we wish to report on the spontaneous course of acromegaly in 5 patients who did not receive any treatment during a median follow-up of 8 years (range 5 -16 years) after the diagnosis was made on the basis of abnormal GH values after a glucose load. Reasons for withhold¬ ing treatment in these patients were, firstly, a long history of mild symptoms and signs (4 cases), secondly, absence of diabetes mellitus, anterior pituitary insufficiency and visual field defects (5 cases) and thirdly, relatively low plasma GH levels (3 cases). Patients and MethodsClinical details of the 5 patients are shown in Table 1. The diagnosis of acromegaly was based on the patient's history and physical examination and confirmed in all cases by typical radiological findings and by inadequate