Background: Acromegaly is associated with multiple co-morbidities and increased mortality. Surgery is the first-line intervention and remission of acromegaly can restore normal life-expectancy. Pre-operative somatostatin analogues (SSA) may increase the likelihood of remission in large invasive tumours by causing tumour shrinkage prior to surgery.
Aims: To audit the management of acromegaly patients at Imperial College Healthcare NHS Trust (ICHNT) against the 2018 consensus statement on acromegaly therapeutic outcomes and subsequent remission rates compared to recently published meta-analyses.
Methods: All patients diagnosed with acromegaly from 2008 to 2019 at ICHNT were identified. Electronic patient records were reviewed for biochemical data at diagnosis and post-surgery. Early remission, defined as an age- and gender-normalised IGF-1 and random growth hormone <1 mcg/l, was assessed 3−6 months post-operatively. Patients were categorised as presenting with microadenomas (Mic), or macroadenomas with cavernous sinus invasion (MacI) or without invasion (MacNI). Administration of pre-operative SSA was recorded.
Results: Seventy-five patients with acromegaly were identified (Mic n=12; MacNI n=42; MacI n=21). Ninety-one percent (n=68/75) underwent endoscopic trans-sphenoidal pituitary surgery as their primary intervention, 5% (n=4/75) received primary medical therapy, 3% (n=2/75) primary radiotherapy, 1% (n=1/75) no intervention. Twenty-six percent (n=18/68) of surgical patients received pre-operative SSA, but remission rates were similar to those who did not (50% vs. 49%, P=0.94). Post-operative remission rates were 67% (n=6/9) for Mic, 68% for MacNI (n=27/40), but only 5% (n=1/20) for MacI.
Conclusions: Remission rates following surgery at ICHNT were comparable to previously reported rates of 67−83% for Mic and 63.3−76.3% for MacNI. Lower remission rates (41%) have been reported for MacI, and cavernous sinus invasion has been reported to negatively correlate with remission. Our low MacI remission rate (5%) may be due to the inclusion of debulking surgeries where remission would not have been expected. Pre-operative SSA treatment did not alter the biochemical remission rate.