Acromegaly is usually diagnosed after several years of duration. The multimodal therapy surgery, radiotherpy, pharmacotherapy is necessary in the majority of patients. Register of sellar tumors (RESET) collecting data of patients from eight tertiary centers in the Czech and Slovak Republics since the year 2000 was established in 2008.
Aim of analysis: Evaluation of diagnostics of acromegaly and effectiveness of its treatment in a daily practice in CR and SR in a period 1.1.20003.9.2013.
Patients and results: 343 patients (185+158 from CR a SR, resp., 189 women, mean age at diagnosis 49 years; for men 46 and for women 52 years). Median time of follow-up was 39.3 months. Three quarters had macroadenoma. In the time of diagnosis 44% of patiens had arterial hypertension (38%) or diabetes mellitus (17%), respectively both (11%). Operated were 81% of patients (reoperated 5%); 93% of operations were transsfenoidal. Normalised IGF1 3 months after surgery was in 54.5% of patients with microadenoma and in 42.4% with macroadenoma. Residual hormonal activity after surgery was treated in the majority of patients with combined radiotherapy and pharmacotherapy. Irradiated were 166 patients and 91% of them underwent radiosurgery with gamma-knife. Long-term pharmacotherapy applied was with somatostatin analogs in 90, dopamine agonists in 69 and with pegvisomant in 37 patients; either alone or in combination. Patients with operation as part of the complex therapy had faster suppression of hormonal activity.
Conclusions: Acromegaly is a serious disease frequently complicated with hypertension and diabetes mellitus. 75% of patients have macroadenoma. The fastest suppression of disease activity is achieved when therapy comprise surgery, alone or in conjunction with other modalities. An individually tailored multimodal therapy is necessary in the majority of patients.
The project is supported by a grant of Novartis.