Endocrine Abstracts (2004) 7 P83

An audit of acromegaly in North-East Scotland: increased use of medical therapy enables preservation of pituitary function

AK Viswanath, SA Booth, P Abraham & JS Bevan

Department of Endocrinology, Aberdeen Royal Infirmary, Foresterhill, Aberdeen, UK.

Annual reports have been provided to the UK Acromegaly Database on 72 patients seen in Aberdeen during the past decade (41 women, mean age at diagnosis 47 yrs, mean GH at diagnosis 59 mU/l and 60% with macroadenomas). Thirty percent had glucose intolerance and 33% hypertension. Fifty-eight percent underwent surgery, 36% external radiotherapy (XRT, either alone or as adjuvant therapy) and 17% primary medical therapy (PMT, 4 had declined surgery). Thirty-seven percent are currently receiving a somatostatin analogue (SA) and 22% a dopamine agonist (DA). Overall, forty percent have hypopituitarism: pan- (n=6), anterior (11), gonadotrophin (GT) and TSH deficiencies (5), and isolated GT (4) and TSH (3) deficiencies. Seventy-six percent of patients who received XRT developed some degree of hypopituitarism. Thirteen patients have died since 1992 at a mean age of 73 yrs (malignancy 5, vascular disease 4 and pneumonia 3): all death certificates were reviewed but details were frequently inadequate. Forty-six patients are being currently followed in Aberdeen (mean duration, 14 years), 9 are lost to specialist follow-up (due, in part, to the geographical difficulties of our remote and rural region) and 4 are reviewed in other centres. All patients under endocrine unit follow-up had IGF-1 data. Modified consensus criteria for control of acromegaly (after Giustina et al., 2000) were applied; overall, seventy-six percent are well-controlled, 18% have sub-optimal control and 6% have poor control. Seven patients are receiving PMT (SA 6, DA 1); six are well-controlled and none has hypopituitarism. Of 33 patients diagnosed during the past decade, only 4 were given XRT; 82% are well-controlled and 82% have normal pituitary function. The recent decline in use of XRT and increased use of medical therapies has therefore enabled maintenance of essentially normal pituitary function in the majority of patients.

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