ECE2023 Rapid Communications Rapid Communications 3: Pituitary and Neuroendocrinology 1 (6 abstracts)
The Reassessment of Therapeutic Decisions by Clinicians According to the SAGIT® Instrument in Acromegaly: Results of a Multicenter Study
Seda Turgut 1 , Sema Ciftci 1 , Nusret Yilmaz 2 , Serhat Uysal 3 , İlkin Muradov 3 , Elif Kılıç Kan 4 , Guven Baris Cansu 5 , Gülşah Yenidünya Yalın 6 , Ziynet ALphan Uc 7 , Göktuğ Sarıbeyliler 6 , Esma Pehlivan 8 , Gulay Simsek Bagir 9 , Seher Tanrikulu 10 , Guzin Yaylali 11 , Fuat Mısıroğlu 1 , Tülay Omma 12 , Ozlem Soyluk Selcukbiricik 6 , İlkay Cakir 1 , Banu Sarer Yurekli 8 , Melek Eda Ertorer 9 , Pinar Kadioglu 3 , Fusun Saygili 8 & Sema Yarman 6
1Bakırköy Dr. Sadi Konuk Training and Research Hospital, Endocrinology and Metabolism, Istanbul, Turkey; 2Faculty of Medicine, Akdeniz University, Endocrinology and Metabolism, Antalya, Turkey; 3Istanbul University Cerrahpasa Faculty of Medicine, Endocrinology and Metabolism, Istanbul, Turkey; 4Faculty of Medicine, Ondokuz Mayıs University, Endocrinology and Metabolism, Samsun, Turkey; 5Faculty of Medicine, Kütahya Health Science University, Endocrinology and Metabolism, Kütahya, Turkey; 6Faculty of Medicine, Istanbul University, Endocrinology and Metabolism, Istanbul, Turkey; 7Usak Research and Training Hospital, Endocrinology and Metabolism, Usak, Turkey; 8Faculty of Medicine, Ege University, Endocrinology and Metabolism, Izmir, Turkey; 9Baskent University Faculty of Medicine, Adana Dr. Turgut Noyan Teaching and Medical Research Center, Endocrinology and Metabolism, Adana, Turkey; 10Acıbadem Hospital, Endocrinology and Metabolism, Istanbul, Turkey; 11University of Pamukkale, Faculty of Medicine, Endocrinology and Metabolism, Denizli, Turkey; 12University of Health Sciences, Ankara Training and Research Hospital, Endocrinology and Metabolism, Ankara, Turkey
Objective: SAGIT, a new instrument designed for therapeutic decision, is not routinely used yet. While the medical treatment was mostly planned according to disease activity by hormonal evaluation, the therapeutic decision has tried to be standardized with the SAGIT instrument. The aim of this study is to reassess the therapeutic decisions by clinicians in the management of acromegaly according to the SAGIT instrument.
Material and Method: This multicenter, retrospective study was conducted at twelve experienced centers from our country and included patients with acromegaly who needed medical treatment, primary or post-surgery. Characteristics of patients and the components of SAGIT:(S) signs/symptoms, (A) associated comorbidities, (G) growth hormone (GH) levels, (I) insulin-like growth factor-1 (IGF1) level, and (T) tumor features were recorded at baseline, before and 3,6, and 12 months after medical treatment. The relationship between SAGIT scores and therapeutic decisions was evaluated.
| Medical Treatment DoSemodification | ||||
| Unchanged | Increased | Decreased | ||
| SAGIT 3rd month scores(n=238)(n,%) | <6 | 59(89.4) | 6(9.1) | 1(1.5) |
| ≥6 | 63(36.6) | 99(57.6) | 10(5.8) | |
| SAGIT 6th month scores(n=198)(n,%) | <6 | 57(79.2) | 12(16.7) | 3(4.2) |
| ≥6 | 55(43.7) | 67(53.2) | 4(3.2) | |
| SAGIT 12th month scores(n=221)(n,%) | <6 | 73(81.1) | 7(7.8) | 10(11.1) |
| ≥6 | 59(45) | 69(52.7) | 3(2.3) | |
Results: Of 322 (175 females/147 males) patients enrolled, 38 patients received primary medical treatment, whereas 284 patients received post-surgical medical treatment. A SAGIT score of 6 was significantly detected as the optimal cutoff for an evaluation of acromegaly disease activity based on hormonal control only with GH and IGF1 levels at each visit. The clinician’s therapeutic decisions at every visit were assessed according to the cutoff level of SAGIT score for disease activity (Table 1). In patients with the uncontrolled disease according to the SAGIT score at the 3rd and 6th months visits and whoSemedical treatment was unchanged, a significant decrease in SAGIT score both between the 3rd and 6th, and 6th and 12th months were found (P=0.002, P<0.001, respectively). However, it was revealed that adequate disease control could not be achieved as the SAGIT scores remained at 6 and above for both the 6th and 12th months visits.
Conclusion: If clinicians had changed therapeutic decisions according to the SAGIT criteria, more than 50% of patients would have required treatment intensification for the patients found to be uncontrolled according to the optimal cutoff SAGIT score of 6, also shown in the validation studies. As a result, the SAGIT scores of these patients remained equal to or above the cutoff point during the 12-month follow-up. This result showed that the SAGIT instrument should be emphasized more strongly to achieve individualized treatment.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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