Endocrine Abstracts

Introduction: High incidence of polyp formation and mucosal hypertrophy in paranasal sinuses have been reported in patients with acromegaly. Lund-Mackay score is widely used to stage chronic rhinosinusitis.

Aim: To assess changes in Lund-Mackay score after surgical or medical treatment of acromegaly and their relation to biochemical disease activity.

Methods: Records of patients with paired (before and after treatment) pituitary/sinus imaging (CT or MRI) performed between 1/2007 and 5/2018 were reviewed. Each imaging was assigned a Lund-Mackay score. Comparisons were made between pre- and post-treatment scores and these were correlated with IGF-I levels [times upper limit of normal range (ULN)].

Results: Eighty-four cases were identified [median age 45.4 years (21–72), 41 males/43 females]. Majority had macroadenoma (88%). All had active acromegaly at pre-treatment Lund-Mackay score assessment (prior non-curative transsphenoidal surgery had been performed in 15). Median score was 1 (0-21); 11 patients (13%) (5 males/6 females) had significant sinus disease (Lund-Mackay score >3). There was no correlation between pre-treatment scores and ULN IGF-I. At post-treatment score assessment, 50 patients (31 females) were on acromegaly remission and had median score 1 (0–10); 34 patients (12 females) had improved IGF-I but were not in remission and had median score 0 (0–15). Median intervals between two score assessments were 18.7 months (3–91) in the former and 24 months (4–117) in the latter groups. No significant differences were detected between pre- and post-treatment Lund-Mackay scores in both remission and no-remission groups (P=0.642 and P=0.363 respectively). Two patients (2/11, 18%) with Lund-Mackay score >3 showed improvement after treatment (one each in both treatment outcome groups).

Conclusions: Staging of chronic rhinosinusitis with Lund-Mackay scores does not correlate with acromegaly biochemical activity. In our series, 13% of the patients had significant sinus disease which changed in a small minority after acromegaly treatment.