Endocrine Abstracts

Aim: Acromegaly is associated with premature dead and a number of risk factors for cardiovascular disease (CVD). We aimed to examine the concept of cumulative GH exposure with regard to the presence these risk factors and cancer in acromegalic patients.

Methods: Retrospective observational study in all acromegalic patients from 2006 to 2017 with a minimum of 3 years of follow-up. We exclude patients not treated. GH exposure was calculated as median GH or IGF1 multiplied by the years of follow-up. We also calculate IGF1, % IGF1 above ULN for sex and age. We also used Sagit scale to access comorbidities. We review clinical registries of those patients, and categorized them in disease remission, controlled by therapy or active disease. We used descriptive statistics, t-test for continuous variables and chi-squared distribution for categorical variables. The threshold for statistical significance was P<0.05 for each test.

Results: We found 77.9% macroadenomas, 18.2% microadenomas and 3.9% invasive in 78 acromegalic patients. The mean age at diagnose was 51±18.9 years and 68% were female. Most patients were submitted to surgery and transphenoidal resection was the first treatment in 76.2% of patients. Radiotherapy was used in 2.6%, in the early years for those who refuse the surgery. As first therapy, somatostatin analogues were prescribed in 6.6% of patients and dopamine agonists in 10.3% reflecting the high frequency of somatomammotrophic pituitary adenomas. They were followed-up for 12.0±0.2 years. The same drugs, Pegvisomant, subsequent surgery or radiotherapy were also used for those that do not achieved the safety levels of the guidelines. At the last evaluation 42.3% of the patients were on remission, 38.5% had the disease controlled by therapy and 19.2% had active disease in spite of the current treatment. The prevalence of hypertension was 65.4%, diabetes 39.4%, coronary artery disease 32.1% and 14.1% had also cancer. Only sleep apnea (present in 10.3% of patients) was significantly associated with the IGF1 exposure (P=0.043). Death occurred in 15.4% of patients during the follow-up. They were older with longer duration of follow-up. GH exposure was significantly associated with larger tumors with supra selar extension.

Conclusions: We found significant associations between GH or IGF1 exposures with larger tumors, but not with the prevalence of CVD, CVD risk factors or cancer. Only OSA was significantly associated with IGF1 exposure. These findings are new and deserve further evaluation in larger populations, with a prospective design.