Long and short-term therapy effectiveness with dopamine agonists in acromegaly in the Republic of Uzbekistan
Said Ismailov, Zamira Khalimova, Adliya Kholikova, Yulduz Urmanova, Liliya Murtazaeva, Dinara Alieva, Khurshida Nasirova & Gulrukh Alimukhamedova
Aim of the research: To study long and short-term therapy effectiveness with dopamine agonists in acromegaly.
Patients and methods: Three hundred and sixty-nine patients with acromegaly registered by December, 1 2009 in the Republic of Uzbekistan. Of these patients we observed 20 cases with GH-secreting pituitary adenoma. Age of the patients was from 19 to 63 years-old (mean age 40±19 years-old), duration of the disease was from 1 to 23 years. Patients underwent clinical and biochemical assessment such as pituitary and peripheral endocrine glands RIA tests, CT and MRI imaging of the pituitary, US of internal organs and thyroid as well as visual fields, fundus, visual acuity and neurological evaluation.
According to the duration of the disease we divided patients into two groups: 1st group with the duration of the disease of 15 years (10 patients with mean duration of 2.6±1.2 years), 2nd group with the duration of the disease 6 and more years (10 patients with mean duration of 8.2±2.2 years). All patients received sole Parlodel (Bromergon, Bromocriptine) 57.5 mg per day, however in some patients compliance was poor.
Results: Five year follow-up of patients with medical treatment allowed us to reveal increase in cardiovascular complications in both groups despite regular dopamine agonists treatment. In first group these numbers increased by 90% while in second group elevated by 100%. Central and peripheral nervous system complications also increased in 8 patients from 1st group and in 10 patients from 2nd group. Besides, all 20 patients had endocrine complications such as amenorrhea in all women, lactorrhea in 12 patients, thyroid nodules in 9 patients and diabetes mellitus anf impaired glucose tolerance in 2 and 6 patients respectively. Nervous and gastrointestinal system disorders were similar in both groups and showed 90% of complications. Respiratory system complications were rare and did not increase during 5 years (20% in first group and 40% in second group). Growth of oncology rate also did not revealed.
Conclusions: i) Treatment with dopamine agonists in patients with acromegaly is not effective to suppress the activity of the disease and stop the adenoma growth; ii) in order to reduce complications and to improve the quality of life of the patients complex therapy recommended such as surgical and medical with more effective agents, e.g. somatostatine, or radiotherapy with medical treatment depending on lesion size and patients age; iii) analysis of complications development depending on the duration of the disease showed less effectiveness of medical therapy alone. In this case on early stages of the disease to decrease complications rate and to improve the quality of life of the patients complex therapy recommended medical and radiotherapy or medical and surgical depending on tumor size and age of the patient.