Endocrine Abstracts

Introduction: Effective acromegaly treatment in the era of somatostatin analog therapy may initially seem easy to apply. Several factors, modifiable or not, may be involved in every patient’s treatment. The aim of this study was to evaluate possible factors affecting effective acromegaly treatment.

Methods: From the original pool of 25 patients, that were diagnosed with acromegaly in our department during the last 15 years, 18 are currently being followed and were evaluated in present study, with median (range) age 65 (34–84) years and 8 (44.44%) males. Demographic characteristics were recorded and clinical, biochemical, metabolic and hormonal parameters were evaluated. Treatment outcome was evaluated from baseline IGF-1 and GH values and GH nadir after 75 gr. OGTT under current treatment.

Results: All our patients harbored pituitary adenomas with initial maximal diameter of median(range) 10 (3–35) mm. Thirteen patients underwent selective trans-sphenoidal pituitary surgery, two received adjuvant radiotherapy with image-guided stereotactic radiosurgery, fifteen are currently receiving somatostatin analog therapy, six are treated with dopamine agonist co-administration and two are receiving pegvisomant. Twelve patients are considered to be adequately treated based on both IGF-1 (<220 ng/ml) and GH nadir (<1 ng/ml) values, whereas six patients are still out of normal IGF-1 range. These patients had higher GH nadir values upon initial diagnosis (Spearman’s rho=0.63, P=0.02), are of lower chronological age (rho=−0.56, P=0.013) and they are less compliant to periodical assessment (rho=−0.64, P=0.0039), mainly due to lower socioeconomic status and less access to health insurance benefits. These patients also suffer more from arthropathy (rho=−0.56, P=0.014) and have raised triglyceride levels (rho=−0.51, P=0.03), probably as a consequence of GH excess.

Conclusions: Lower socioeconomic status of acromegaly patients is probably associated with less patient compliance and poor treatment outcomes, affecting overall quality of life and eventually survival.