Endocrine Abstracts (2012) 29 P1391

Evaluation of clinical presentation, treatment approach and outcome of a cohort of patients with acromegaly: a single centre experience

S. Gouveia, I. Paiva, C. Ribeiro, A. Vieira, M. Alves, J. Saraiva, C. Moreno & M. Carvalheiro

Coimbra’s University Hospital, Coimbra, Portugal.

Introduction: Acromegaly is a rare disease with a high morbidity and mortality rate.

Our aim was to characterise the population with acromegaly that is currently under supervision at our Department.

Materials and methods: We included 104 patients with acromegaly (mean age at the diagnosis 44.0±13.0; with 71.2% females).

The referred population was analysed on what concerns disease’s duration, clinical manifestations and complications, other pituitary hormone hyper/hyposecretion, adenoma size, histological type, treatment option and adverse effects.

Results: On average, these patients have been followed for 15.8±8.8 years. At diagnosis, 99% were symptomatic (86.7% with morphologic complaints). 39.1% had concomitant hyperprolactinemia and 32.6% hypopituitarism (86.7% hypogonadism, 26.7% hypothyroidism and 16.7% hypoadrenalism). At least one complication was developed in 88.3%.

A pituitary adenoma was found in 99% cases (77% macroadenomas). A familial syndrome was identified in 1.9% (one MEN1; one Carney complex).

Taking into account therapeutic options, 94.2% underwent at least one surgery (75.5% one, 19.4% two and 5.1% three surgical interventions). Regarding the first surgical approach (87.8% transsphenoidal), an adverse outcome occurred in 22.4% patients (77.3% hypopituitarism; 18.2% diabetes insipidus). Biochemical and significant size reduction was respectively achieved in 29.9 and 59.8%; the disease persisted in 40.2%. A full/partial recovery from other pituitary hormone hyper/hyposecretion was accomplished in 65.2%.

Pharmacotherapy was performed in 80.8% (9.5% as primary treatment); one third displayed a side effect.

From the 19.2% subjected to radiotherapy (85% conventional), 50% progressed to hypopituitarism.

Conclusion: In this cohort the majority of patients was symptomatic at diagnosis, revealing typical morphologic features. Furthermore, 77% had a macroadenoma, which could account for worse surgical outcome. Still, the disease is under control in 59.8% and improvement of presurgical hyperprolactinemia/hypopituitarism was noticed in 65.2% cases.

An endocrine, cardiac, respiratory, renal, gastrointestinal or osteoarticular complication was detected in 88.3% patients, decreasing their quality of life and life expectancy.

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.

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