Evaluation of clinical presentation, treatment approach and outcome of a cohort of patients with acromegaly: a single centre experience
S. Gouveia, I. Paiva, C. Ribeiro, A. Vieira, M. Alves, J. Saraiva, C. Moreno & M. Carvalheiro
Introduction: Acromegaly is a rare disease with a high morbidity and mortality rate.
Our aim was to characterise the population with acromegaly that is currently under supervision at our Department.
Materials and methods: We included 104 patients with acromegaly (mean age at the diagnosis 44.0±13.0; with 71.2% females).
The referred population was analysed on what concerns diseases duration, clinical manifestations and complications, other pituitary hormone hyper/hyposecretion, adenoma size, histological type, treatment option and adverse effects.
Results: On average, these patients have been followed for 15.8±8.8 years. At diagnosis, 99% were symptomatic (86.7% with morphologic complaints). 39.1% had concomitant hyperprolactinemia and 32.6% hypopituitarism (86.7% hypogonadism, 26.7% hypothyroidism and 16.7% hypoadrenalism). At least one complication was developed in 88.3%.
A pituitary adenoma was found in 99% cases (77% macroadenomas). A familial syndrome was identified in 1.9% (one MEN1; one Carney complex).
Taking into account therapeutic options, 94.2% underwent at least one surgery (75.5% one, 19.4% two and 5.1% three surgical interventions). Regarding the first surgical approach (87.8% transsphenoidal), an adverse outcome occurred in 22.4% patients (77.3% hypopituitarism; 18.2% diabetes insipidus). Biochemical and significant size reduction was respectively achieved in 29.9 and 59.8%; the disease persisted in 40.2%. A full/partial recovery from other pituitary hormone hyper/hyposecretion was accomplished in 65.2%.
Pharmacotherapy was performed in 80.8% (9.5% as primary treatment); one third displayed a side effect.
From the 19.2% subjected to radiotherapy (85% conventional), 50% progressed to hypopituitarism.
Conclusion: In this cohort the majority of patients was symptomatic at diagnosis, revealing typical morphologic features. Furthermore, 77% had a macroadenoma, which could account for worse surgical outcome. Still, the disease is under control in 59.8% and improvement of presurgical hyperprolactinemia/hypopituitarism was noticed in 65.2% cases.
An endocrine, cardiac, respiratory, renal, gastrointestinal or osteoarticular complication was detected in 88.3% patients, decreasing their quality of life and life expectancy.
Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.
Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.