Therapeutic trends, long-term outcome and efficacy of different treatment modalities in acromegaly: a single center registry covering a 40 year period
M. Tzanela, O. Karapanou, A. Assimakopoulou, L. Papastathopoulou, M. Christophoraki & S. Tsagarakis
The aim of the study was to examine the therapeutic trends and the long-term outcome of available therapeutic modalities for acromegaly in a single center over a 40 year period.
We retrospectively studied 300 acromegalic patients (131 men, 169 women, 153 macroadenomas and 147 microadenomas) from 1970 until 2010; 154 patients were diagnosed before 1990 (group A) and 146 after 1990 (group B). Outcome was evaluated by IGF1 and GH (random plus post OGTT) measurements.
The outcome of each treatment modality in the two groups of the cohort is shown in Table 1.
Surgery (TSS) and somatostatin analoges (SSA) were used more often in group B (TSS: in 62% of patients vs 40% in group A, P=0.0001, SSA: 52 vs 6.4% respectively, P=0.0001), while pituitary irradiation was used less often in group B (30 vs 56.4% P=0.0001). Overall the outcome at latest follow-up following all treatment interventions in groups A and B respectively was as follows: 40.6 vs 66.3% achieved GH<2.5 ng/ml, P=0.0001; 20 vs 42.8% achieved GH<1.0 ng/ml, (P=0.0001); 15.2 vs 34.9% achieved GH nadir post OGTT <0.4 ng/ml (P=0.004); and 50.4 vs 68.1% achieved normal IGF1 (P=0.04).
Conclusions: These results indicate that in our cohort the evolution of treatment modalities in favor of TSS and medical treatment resulted in a better overall outcome of acromegaly in patients treated during the last 20 years. However, the disease still remains uncontrolled in a substantial proportion of patients.
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.