Unsatisfied treatment outcomes of acromegaly patients: a single center experience in Turkey
Feyza Yener Ozturk, Esra Cil, Aysenur Ozderya, Ozcan Karaman, Sayid Shafi Zuhur & Yuksel Altuntas
Background: Acromegaly is a multi-systemic dysfiguring disease caused by pituitary GH secreting tumour. Pituitary surgery, medical treatment with somatostatin analogues and radiotherapy have been cornerstone in the management of acromegaly. However, all these treatment modalities do not provide sufficient disease control especially in patients with macroadenomas.
Objective: To evaluate the follow-up outcomes and remission rates of acromegaly patients.
Method: Fifty acromegalic patients diagnosed between 2005 and 2009 at Sisli Etfal Training and Research Hospital were retrospectively analysed. Normal IGF1 serum concentrations for age and sex, nadir GH <1 ng/ml during OGTT and random GH <2.5 ng/ml were defined as biochemical control.
Results: The mean age of patients was 46.56±12.95 years (age range: 2576 years). Preoperative mean concentrations of GH were 33.72±68.45 ng/ml (range: 2.01106 ng/ml), IGF1 were 1154.88±710.83 ng/ml (range: 3083574 ng/ml) and nadir GH during OGTT was 17.22±23.76 ng/ml (range: 1.984 ng/ml). Forty-six patients had macroadenomas (92%). Forty-five patients (90%) underwent surgery at different centers after the diagnosis. Five patients (10%) were followed with primary somatostatin analogue treatment. Postoperative cure was defined in 8 of 50 patients (16%). Postoperatively active 9 patients (18%) were treated with radiotherapy and 35 patients (70%) were started on treatment with octreotide LAR as 10, 20 and 30 mg. According to the follow-up data, biochemically disease control was defined in 20 of 50 patients (40%). Twenty-two patients (44%) had active acromegaly. A discordance was found between serum IGF1 concentrations and nadir GH during OGTT in 8 of 50 patients (16%). However, remission was defined in all of these 8 patients if only serum IGF1 concentrations were assessed for disease control.
Discussion: Maximum doses of somatostatin analogues and combined treatment modalities do not provide effective control in the majority of patients. Newly developing treatment options (GH receptor antagonist, pasireotide…) should be used in the management of active disease.