Endocrine Abstracts

The aim: To determine the prognostic parameters affecting the course of acromegaly (A.) and the effectiveness of drug therapy (MT).

Matherials and methods: 779 patients of A. [218 men (28%)] aged 60 (48/69) years, [Me(25%/75%)] were included in the Moscow register. The prevalence of A. in Moscow is 61.6; the incidence is 4.0 cases/million inhabitants. The treatment algorithm included surgical aid (495 patients), primary (I) or secondary (II) MT (584) and radiation treatment (115). Radical adenomectomy was performed in 31% of patients. 69% of patients with pituitary macroadenomas were prescribed II MT. The effectiveness of treatment was assessed by the dynamics of the GH, IGF-1, IGF-1 index (IGF-1/ULN).

Results: An inverse correlation was revealed between the age of diagnosis, the content of GH, IGF-1 and the volume of the pituitary tumor [(r=-0.24; -0.13; -0.41, respectively, (P<0.001)], which indicates a more active course of the disease with its early manifestation. I MT was received by 295 (69 m), II MT – 289 (106 m) patients. Somatostatin analogs of the first-generation (SA1) (lanreotide and octreotide) and cabergoline were used. A retrospective analysis of the effectiveness of MT was carried out between non-selective and selective groups. The selective groups for I and II MT included patients (72 and 50 patients) with a decrease in the level of IGF-1 of more than 70% of the baseline level after 3 months of taking SA1. Control A. at I/II MT in nonselective groups was achieved in 48 and 58% of cases, whereas in selective groups in 72 and 80% of patients [IGF-1 index was 0.9(0.4) and 0.8(0.3), respectively, P<0.001]. The duration of effective MT in selective groups with I MT was 49 (49) vs. 29 (29), with II MT – 53 (48) vs. 30 (37) months (P=0.0001). In both I and II MT, a moderate correlation was found between a decrease in the level of IGF-1 after 3 months of treatment, levels of IGF-1 after 12 months of treatment and at the last visit, as well as the duration of disease control [r=-0.57 (-0.51); r=-0.61 (-0.43); r=-0.58 (-0.4); r=0.52 (0.43), respectively, (P<0.001)].

Conclusion: 1. Independent signs associated with the effectiveness of SA1 are: the level of IGF-1 after 3 months of treatment, the initial value of the IGF-1 index and the age of diagnosis. 2. Predictors of low sensitivity to SA1 treatment are: young age of diagnosis; male gender; large size of adenoma; the value of the IGF-1 index >2.7.