Objective: The aim of our study was to investigate the characteristics of the acromegalic patients followed at a tertiary Universitary Hospital and to evaluate the results of the recommended treatment protocols.
Patients and methods: All our acromegalic patients were included (n=48; 27 women). Demographic, hormonal, visual and imaging data at diagnosis and during follow-up, as well as treatments applied, were recorded.
Results: In 73.0% of the patients acromegaly was due to a pituitary macroadenoma. Of those under periodic surveillance, 68.2% were operated (60% of them in our hospital, 40% in other hospitals) and 36.4% were submited to radiotherapy. At the time of the study 88.6% of the patients were receiving medical therapy, 28.2% of them as first-line treatment. Following actual criteria (Melmed et al. 2005), only one patient was cured by surgery. Considering age and sex-matched normal concentrations of IGF-I as a criteria of control, surgery resulted in disease control in 10% of the operated patients, while medical treatment controlled the disease in 76.9% (P<0.05). This percentage was 75.0% in the group of patients who received medical therapy as adjuvant of surgery and/or radiotherapy and 81.8% in the group of patients who received medical treatment as first-line treatment (P=NS). After surgery visual function improved in 6 patients, hypopituitarism improved in 6, and some degree of de novo hypopituitarism developed in 5. Results of the surgical procedures performed in our centre were similar to the results obtained in other hospitals. Of those who received medical therapy as first-line treatment, the tumor size decreased in 45.5% and in the rest no significant changes were observed during follow-up.
Conclusions: Not all centres obtain the results reported in the literature in terms of disease control and morbidity after surgical treatment of growth hormone secreting tumors. It is possible that in some hospitals first-line medical treatment should be chosen, unless the patient has visual disturbances, as long as it is not clear that partial surgical removal of the tumor significantly improves response to medical therapy or that it reduces its costs.