Efficacy of acromegaly treatment in six Czech and Slovak tertiary centers: first analysis of patient registry RESET (Registry of Sellar Tumors)
Václav Hána1, L Bandurova1, P Brabec8, J Cap2, V Durovcova1, V Hana1, Z Jarkovska1, P Kentos5, R Klapka8, K Klimasova8, D Klimes8, M Krsek1, I Lazurova6, V Olsovska3, J Podoba4, M Pura5, H Siprova3, J Steno7, M Sticha8, L Trejbalova4, P Vanuga5, H Wagnerova6, V Weiss1, D Zeman3, L Dusek8 & J Marek1
Acromegaly is frequently diagnosed late and pituitary macroadenoma is revealed in the majority of patients. Treatment usually needs combination of several treatment modalities to suppress the disease activity. Efficacy of our treatment of acromegaly was not analysed till now.
Aim: First analysis of the diagnostics of acromegaly, efficacy of treatment, its complications and status of acromegaly patients in six tertiary referral centers in the Czech Republic and Slovakia.
Methods: Registry of patients with sellar tumors (RESET) was developed. Data of patients registered in six centers since January 1, 2000 were entered.
Results: Data of 137 patients (86+51, CR+SR, 71 women, age 2078 years, mean 47 years) were analysed. Diagnosis was established in mean age 47 years. Main signs and symptoms were acral enlargement (in 87%, realised by patient in 45% or by physician in 31%), sweating (54%), headache (35%), joint pain (31%), fatigue (26%) and paresthesias (22%). Complications like arterial hypertension (33%) and diabetes melitus (17%) were present in 49% of patients in time of diagnosis. 71% of patients had pituitary macroadenoma. Treatment before referral to tertiary centers did not significantly suppress activity. A combined treatment with surgery, radiotherapy and pharmacotherapy was most frequently needed to suppress the disease activity. Operated were 75% of patients (reoperated 7%) and majority of them transnasaly (91%). Irradiated were 43% of patients majority of them by Leksell gamma knife (LGK, 88%). Pharmacotherapy was represented most frequently by somatostatin analogues (51%), dopamin agonists were used in 36% and pegvisomant in 9%. Operation suppressed basal GH below 2.5 μg in 49%, below 1 μg/l in 35% and normalised IGF-1 in 29%. Combined treatment of LGK plus pharmacotherapy suppressed GH below 2.5 μg/l in 92%, below 1 μg/l in 65% and normalised IGF-1 in 61%. SMSA treatment suppressed GH below 2.5 μg/l in 62%, below 1 μg /l in 35% and normalised IGF-1 in 41%.
Conclusions: An individually tailored combined treatment with modern modalities is used in Czech and Slovak Republics and effectively suppresses the acromegaly activity in the majority of patients. An early referral to tertiary centers is substantiated. Better treatment results could be expected with earlier disease identification. The project is supported by a grant of Novartis.