We have audited control of acromegaly in a specialist endocrine unit in Oxford now that this should usually obtainable. We have 240 patients under active surveillance, seen annually since diagnosis. Data from 115 of these seen in the last year have been used for this analysis.
Methods: We grouped patients according to whether they were controlled in either or both IGF1 and GH or uncontrolled. Controlled IGF1 was defined according to age and sex and GH was defined as basal <5 mU/l (<2 μg/l). We analysed the most recent IGF1 and GH values and compared these to initial GH levels, initial tumour size and the types of treatment given.
Results: Control of GH 72% (n=83), control of IGF1 62% (n=71), control of both 49% (n=56), uncontrolled of both 13% (n=15).
Control of IGF1- vs initial tumour size; extrasellar macro-, intrasellar macro- and microadenoma (71%, 58%, 56%) and for control of GH- (71%, 54%, 88%)
High GH (>50 mU/l) vs low (<50 mU/l) GH at presentation (74 vs 96% controlled).
Analysis of the factors at presentation of uncontrolled patients were tumour size at diagnosis macroadenoma- 79% and initial GH high at diagnosis 79%.
Conclusions: 1. Even in a specialised unit, control of acromegaly is not invariable after treatment. This may relate in some patients to large tumour size and high initial GH levels at presentation but in some it relates to the inability to obtain funding for expensive drugs.
2. There is a considerable but previously described discordance between GH control (72%) and IGF1 control (62%).
3. Initial tumour size predicates GH control.
4. High levels of GH at commencement of treatment predicate a poorer outcome.
5. Uncontrolled patients almost invariably have a large tumour or initially high GH levels at diagnosis.
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.