Endocrine Abstracts (2006) 11 P63

Relationship between age of onset, natural course and therapeutic approach in patients with acromegaly

EI Marova, VS Pronin, SE Agadzanjan, NN Molitvoslovova, MB Antsiferov & TM Alexeeva

National Endocrinology Centre, Moscow, Russia.

The degree of hormonal activity and the duration of active phase of disease are the most important factors in the pathogenesis of system complications, decreasing life span in patients with acromegaly. To determine the age-related features of the clinical course of disease 140 patients with active acromegaly were examined. All patients were divided into 3 groups: group 1 included 14 patients at the age of 20–39, group 2 – 40–59 (72) and group 3 – ≥60 years (52). The mean age of the onset of disease in 1 group was 27, in 2–37, in 3–51 years old. In the 1st group the mean period from the onset to the diagnosis was 3.5, in 2nd – 6.2, in the 3rd – 9.3 years. The mean level of the GH in the 1st group was 56.8±15.3, in 2nd – 41.2±8.3, in 3rd – 22.9±5.8 ng/ml. The mean level of the IGF-I substantially exceeds the normal levels. In the 1st group macroadenomas were founded in 50%, in 2 – in 57%, in 3 – in 35%. In patients with the onset at the age younger than 30 years the main factor of the pathogenesis is the increased hormonal activity with the development of skeletal and organ changes. The complications are usually caused by extrasellar increase of the tumor with the development of neurologic disturbances. Therefore surgery is the basic method of treatment. In patients with the onset at the age older than 50 years the main factor of the pathogenesis, decreasing life span, is the duration of active phase. There are revealed the expressed cardiovascular, respiratory, metabolic disturbances, and neoplasms. Because of lesions of many organs the most preferable method of treatment is primary drug therapy (long-active somatostatin analogues). Use of surgical treatment is limited.

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