Comparison of different therapy approaches in acromegaly
Zamira Khalimova, Adliya Kholikova, Yulduz Urmanova, Dinara Alieva, Khurshida Nasirova, Gulrukh Alimukhamedova, Liliya Murtazaeva & Shokhsanam Safarova
Aim of the research: To study relationship between GH levels and acromegaly complications development in different therapy approaches.
Patients and methods: We evaluated 50 patients with GH secreting adenomas referred to CCSSE from 1999 to 2004. Age of patients was from 19 to 63 years-old (mean age 40±19 years-old). Duration of the disease was from 1 to 23 years.
Methods: Clinical and biochemical tests of neurological status; RIA assay evaluation of pituitary and peripheral hormones levels; US study of internal organs and thyroid; vision evaluation: acuity, fundus, fields. Patients were divided into three groups: 1st group with medical therapy, 2nd group with radiotherapy, 3rd group with surgical treatment.
Results: We revealed that complicated forms of AM were observed in patients with medical therapy, whereas patients received radiotherapy and those operated developed significantly lower complications.
Summarizing our data we can conclude that the key point for disease and its complications progression is the activity of the disease which is confirmed by high rate of complications in patients with medical therapy and on early radiotherapy stages (several months to 3 years) and in cases of recurrent disease after surgery. The research revealed that in all cases patients had high GH levels, which determines the character of the disease. According to this, it is recommended to use surgery and complex therapy approaches depending on lesion size and patients age.
Conclusions: i) The most less complications development we observed in groups with surgical treatment, whereas in radiotherapy and medical treatment groups complications rate was mild and significantly high respectively. To confirm the causes of these noticeable variables we analyzed the effect of GH levels, duration of the disease in relation with complications depending on therapy approaches. ii) As the studies and observations of acromegalic patients show, the medical therapy with dopamine agonists is not effective in compensating the disease, to regress the adenomas growth and it is impossible to prevent complications development which is confirmed by ineffective monotherapy medical treatment.