ECE2022 Oral Communications Oral Communications 4: Pituitary and Neuroendocrinology 1 (6 abstracts)
Recurrence in acromegaly: a two tertiary centers experience
Elisa Sala 1 , Arianna Cremaschi 1,2 , Giulia Carosi 1,3 , Nazarena Betella 4 , Giulia Del Sindaco 1,2 , Alessandra Mangone 1,2 , Roberta Mungari 1 , Angela Pagnano 1,2 , Rita Indirli 1,2 , Emanuele Ferrante 1 , Gherardo Mazziotti 4,5 , Marco Locatelli 6,7 , Davide Milani 8 , Andrea Gerardo Lania 4,5 , Maura Arosio 1,2 & Giovanna Mantovani 1,2
1Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Endocrinology Unit, Milan,; 2Department of Clinical Sciences and Community Health University of Milan, Milan,; 3Department of Experimental Medicine, Sapienza University of Rome, Rome,; 4Endocrinology, Diabetology and Medical Andrology Unit, Humanitas Clinical and Research Hospital, Rozzano, Italy; 5Department of Biomedical Sciences, Humanitas University, Rozzano, Italy; 6Neurosurgery Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy; 7Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy; 8Neurosurgery Unit, Humanitas Clinical and Research Hospital, Rozzano, Italy
The aim of this study was to evaluate in a long follow-up time patients with acromegaly successfully treated by transphenoidal surgery (TNS) in order to establish the recurrence rate and the need of subsequent follow up.
Methods: We retrospectively analyzed data of 283 acromegalic patients (168 females, mean age: 44.2 ±12.9 years) who underwent TNS for a GH secreting pituitary adenoma between 1980 and 2020, on regular follow-up at two Pituitary Units in the city of Milan (Fondazione IRCCS Ospedale Maggiore Policlinico and IC Humanitas). Diagnosis of acromegaly was defined by the presence of clinical signs and symptoms, an elevated serum IGF-1 level, age and sex matched, and lack of GH suppression based on appropriated criteria for the assay used at the time of diagnosis (GH<2 μg/l using a RIA, 1 μg/l with a modern IRMA or <0.4 μg/l with chemiluminescent assays, CLIA). For recurrence the same biochemical parameters were used.
Results: All patients had preoperative confirmation of acromegaly (mean IGF1: +13.7±9.2 SDS, mean GH nadir: 15.9±26 μg/l). MRI confirmed the presence of a pituitary adenoma in all patients (192 macro) and all patients underwent TNS. At the first follow-up after surgery (mean distance: 3.63±5 months) we defined as not cured 143 patients (50%), as cured 132 (47%) and as “partially cured”, i.e. with normalization of only one parameter between GH suppression and IGF-1 levels, 8 patients (3%). Considering the group of cured patients, at the last follow-up (mean: 109 months after surgery) 5/132 (3.7%) patients needed medical therapy for recurrence. In particular, only 1 patient (0.7%) after 15 months form surgery showed a biochemical status of active acromegaly (IGF1 +5.61 SDS, and GH nadir 1.27 μg/l assessed with CLIA). Four additional patients (3%), after a mean follow-up of 81 months, started therapy for an isolated increase in IGF1 levels (mean IGF1SDS +3.65). In the “partially cured” group, 2/8 (25%) patients showed after 12 and 37 months from surgery a biochemical status of active acromegaly (IGF1 SDS +2.75 and +3.62; GH nadir 0.6 and 0.5 μg/l respectively assessed with CLIA).
Conclusions: Recurrence of acromegaly occurred in less than 1% of patients successfully treated with surgery. More frequently (25%), recurrence occurred in patients with incomplete normalization of either IGF1 or GH after surgery. Our data suggest that most acromegalic patients with complete remission after surgery may be considered as definitely cured, while those in partial remission need a strict endocrinological follow-up.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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