Aftercare in patients with Cushing's disease and acromegaly: is there room for improvement?
Juergen Honegger, Monika Milian & Tsambika Psaras
Objective: Evaluation of aftercare, medical therapy and remission rate in Cushings disease (CD) and acromegaly (AC).
Methods: Of 58 CD and 83 AC patients operated over 10 years were carefully evaluated. The patients received a disease-related questionnaire and were invited for a follow-up at the outpatient clinic of the Department of Neurosurgery. 33 CD and 52 AC patients returned the questionnaire, 25 CD and 37 AC patients participated personally. CD patients underwent a dexamethasone-suppression-test, and IGF1 levels were assessed in AC patients. Data on postoperative therapy were assessed.
Results: CD of 84.8% and AC of 75.0% patients had been followed by endocrinologists. CD of 9.1% and AC of 1.9% patients had been under no aftercare. CD of 96% patients were in remission. A recurrence occurred in four patients, two were newly detected by our study. IGF1 was postoperatively normalized in 25 of 37 AC patients (67.6%). Twenty patients remained in remission, five relapsed. One patient received medical therapy upon recurrence and presented normal IGF1, four patients with relapse were not yet treated. Ten of 12 patients with elevated early postoperative IGF1 received medical therapy that was commenced within 6 months in nine cases. The mean duration of medical therapy was 36 months (range 292). IGF1 was still elevated at the last follow-up in eight of these 10 patients, all of them receiving monotherapy. In four patients, the dose had been increased once.
Conclusions: The postoperative transfer back to the endocrinologist after operative treatment is achieved well in both groups. In uncured AC, medical therapy is initiated early, but options of therapy offer room for improvement. Therapy of recurrence is delayed in both pathologies.