Background: Acromegaly is due to excess Growth hormone (GH) production, usually as result of pituitary adenoma. The diagnosis is often preceded by around 5 years of active but unrecognized disease. Clinical expression of the disease in each patient depend on the levels of GH and Insulin-like Growth Factor-1 (IGF-1), age, tumor size, and the delay in diagnosis. Successful remission after Trans-sphenoidal surgery (TSS) is reported to be found in 52.5% of cases in the developed countries.
Objectives: This study was designed primarily for the evaluation of diagnostic characteristics of acromegaly and establishment of its management outcomes over a span of 10 years at a tertiary care hospital in Pakistan.
Methods: It was a Descriptive cohort study. Total 53 patients with biochemical and radiological diagnosis of Acromegaly were included in study between October, 2005 to September, 2015. Patients medical record files were reviewed and data recorded.
Results: Of the 53 subjects, with mean age of 39.68±14.35 years, 33 (62.3%) were male while 20 (37.7%) were female.The patients presented at a mean duration of 5.90±4.12 years after onset of symptoms. The most frequent complaint was somatic growth features in the form of enlarged hands and feet noted by 51 (96.2%) pts. Overall, 50 (94.3%) patients underwent TSS for removal of pituitary adenoma while 3 (5.7%) patients refused to opt surgical option. Only 3 (6%) patients achieved biochemical and radiological remission after 6 months of surgery. Among 47 patients with persistent disease after TSS, 26 (55.3%) were treated with radiosurgery/radiotherapy, 12 (25.5%) underwent repeat TSS and 9 (19.1%) opted for medical treatment, mostly with Cabergoline.
Conclusion: TSS is followed by the documentation of a high rate (94%) of failure to achieve remission and majority of patients have to opt radiotherapy/repeat TSS for the persistent disease. With the continuously improving surgical skills, we expect that the figures attaining remission after primary TSS will rise in the decades to come.
Keywords: Acromegaly, Characteristics, Management Outcome
20 May 2017 - 23 May 2017