Acromegaly is a chronic debilitating disease due to long term exposure to elevated levels of growth hormone (GH) which leads to excessive growth of both skeletal and soft tissues. It is slowly progressive with 30% increase in mortality rate for cardiovascular disease, respiratory complications and malignancies. The estimated prevalence of the disease is 40 cases per million with 34 new cases per million populations per year. Acromegaly most commonly presents between the third and fifth decade with 610 years delay in diagnosis. Effective treatment can improve the survival to that of aged matched population. In 2003 a core of neuroendocrie-pituitary clinic was established at KHMC with a central referral unit for all satellite army hospital across the county.
Aim: To assess the outcome of medical and surgical treatment of our group of Acromegalics and to evaluate predictor factors of cure.
Patients and methods: Fifty one patients with acromegaly were studied; one elderly patient refused all modalities of treatment. Random GH and mean GH to OGTT, IGF1, and IGFBp3 were assessed prior and after treatment as well as radiological findings. Age, duration of acromegaly, body weight, skin fold thickness and tumor size were evaluated as predictors of favorable outcome.
Results: There were 28males and 23 females with mean age of 43.4±11.9 years (range 2474). The duration of disease was 7.7±8.7 years and of follow up was 9.4±8.55 years (0.522). Ninety percent of patients were having macro adenomas. The mean GH to OGTT (pre versus post op) was 19.7±13.9 ng/ml versus 4.4±7.8 (P<0.0003), IGF1 was 815.5±303.7 versus 415.1±326.7 (P=0.016) and IGFBp3 is 7.6±2.7 vs 5.6±2.2 mg/ml (P=0.049). One third of patients achieved cure the rest is still active. Seventeen patients are medically treated by Somatostatin analogues, 16.7% of whole group achieved cure on treatment. Eight patients received radiotherapy; 50% of them achieved cure. Mean HGH for the group receiving medical treatment (SSA) was 20.33±12.71 ng/ml versus 8.11±10.2 post follow up period. A GH of <15 ng/ml and age <40 years were found to be the strongest predictors of favorable outcome in this cohort.
Conclusions: Cure rate is modest when compared with international rates. Younger age group and lowest growth hormone levels are the strongest favorable predictors to cure. Our patients are presenting late with aggressive tumor which limit the cure rate. Medical therapy achieved acceptable cure rate and plays an important role as adjunctive therapy after surgical resection of pituitary tumor. A multidisciplinary approach toward acromegaly management is recommended.