Treatment outcome in acromegaly: Results from the Beaumont Hospital pituitary database
A Agha1, S Ng1, B Rogers1, J Philips2 & CJ Thompson1
Acromegalic patients have increased morbidity and mortality, which correlate with post-treatment growth hormone (GH) level. Target post-treatment plasma GH level should be less than 2.5 nanograms per millilitre, which predicts normal life expectancy.
We evaluated the prevalence of complications and treatment outcome in 76 acromegalic subjects who attended our unit for surgery between 1978-2002. 60 patients are followed up in a specialised pituitary clinic in Beaumont Hospital. Data was derived from retrospective case note analysis, with 100% ascertainment.
Median follow-up was 9 years (2 months - 24 years). 7 patients (9.2%) died (standardised mortality rate = 3.25, P <0.05), 5 from vascular causes. 31 (40.8 %) had hypertension, 25 (32.8 % ) diabetes or IGT, and 30/40 (75 % ) had left ventricular hypertrophy .14/38 (36.8 %) had colonic polyps. 6 patients (7.9%) had malignancy.
30/73 (40%) patients achieved biochemical remission following surgery, 7/8 (87.5%) with microadenomas, 15/25 (60%) with mesoadenomas and 8/40 (20%) with suprasellar adenomas, (P < 0.001). 3 patients (10%) relapsed after initial successful surgery. 4/10 patients achieved remission following repeat surgery. Somatostatin analogues reduced GH levels by 48.2%, with 11/45( 24.4%) achieving biochemical remission. 18 patients had radiotherapy but follow-up was too short to assess outcome. 3/60 patients in the Beaumont cohort had post-treatment GH levels > 10 nanograms per millilitre, compared with 8/16 (50%) patients followed up outwith Beaumont (p<0.001).
We confirm a high prevalence of complications and increased mortality in this acromegalic cohort. Surgical outcome was comparable to published data, but despite adjunctive medical therapy and radiotherapy, biochemical remission of acromegaly was achieved in only 42/76 patients (55.3%). The poor control of growth hormone in patients followed up outwith Beaumont Hospital emphasises the value of specialised services for patients with acromegaly.