Epidemiology, clinical presentation, treatment and outcome of acromegaly in the island of crete, greece: experience of 3 tertiary centers over a four decade period

Maria Chrysoulaki; Vasiliki Daraki; Maria Sfakiotaki; Paraskevi Tzoutzouraki; Paraskevi Floroskoufi; Grigoria Betsi; Rodanthi Vamvoukaki; Stavrina Vergou; Stefanos Michailidis; Makri Artemis Maria; Elpida Mpouhlaki; Antonela Spanoudaki; Georgios Goulielmos; Christos Lionis; Katerina Stamataki; Paraskevi Xekouki

doi:10.1530/endoabs.99.EP262

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Endocrine Abstracts (2024) 99 EP262 | DOI: 10.1530/endoabs.99.EP262

ECE2024 Eposter Presentations Pituitary and Neuroendocrinology (214 abstracts)

Epidemiology, clinical presentation, treatment and outcome of acromegaly in the island of crete, greece: experience of 3 tertiary centers over a four decade period

Maria Chrysoulaki ¹ , Vasiliki Daraki ² , Maria Sfakiotaki ¹ , Paraskevi Tzoutzouraki ³ , Paraskevi Floroskoufi ⁴ , Grigoria Betsi ² , Rodanthi Vamvoukaki ² , Stavrina Vergou ⁵ , Stefanos Michailidis ⁵ , Artemis Maria Makri ⁵ , Elpida Mpouhlaki ⁵ , Antonela Spanoudaki ⁵ , Georgios Goulielmos ⁶ , Christos Lionis ⁷ , Katerina Stamataki ⁴ & Paraskevi Xekouki ^1,5

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¹University General Hospital of Heraklion, Endocrinology & Diabetes Clinic, Iraklio, Greece; ²University General Hospital of Heraklion, Iraklio, Greece; ³General Hospital St. George, Mournies, Greece; ⁴Venizelio Hospital, Iraklio, Greece; ⁵Medical School, University of Crete, Giofirakia, Greece; ⁶Medical School, University of Crete, Section of Molecular Pathology and Human Genetics, Giofirakia, Greece; ⁷Medical School, University of Crete, Clinic of Social and Family Medicine, Giofirakia, Greece

Acromegaly is a rare and insidious endocrine disease, with increased morbidity and mortality mainly due to delayed diagnosis and inadequate control. There are many population studies assessing the epidemiology of acromegaly in Europe while in Greece, there are no published data except for a few small studies regarding treatment outcome.

Aim: To determine the epidemiology, presentation and outcome in patients with acromegaly in Crete, Greece.

Methods: This is a retrospective observational study using data from the archives of three tertiary hospitals from Heraklion and Chania, for the period of 1983 to 2023. Age at diagnosis, estimated delay in diagnosis, clinical, biochemical, imaging data and disease outcome were recorded.

Results: Eighty-five patients were included in the analysis (51 females, 34 males). The mean age at diagnosis was 44.36±13 years and the mean follow-up time was 16±8 years. Forteen patients (16.4%) were younger than 30 years. The time lag from the onset of symptoms to diagnosis was 5.06 years. The most common presenting symptom was suspicious acromegalic features(coarse facial features/acral growth) followed by headaches (23.9%). A metabolic disease (diabetes, dislipidemia, hypertentsion) was present in 41.1% of patients Macroadenomas were found in 40%, while in 15% of patients, size data were missing. Sixty-four (72.41%) patients underwent surgery, 21 patients (27.6%) received medical treatment only (90% somatostatin analogs (SSAs)) and forty-three (50.1%) received adjuvant treatment; SSAs (50.5%), dopamine agonists (10.5%), radiotherapy (10.7%). Six patients had a second operation (7%). Histology reports were available for 28 cases. Tumor subtype analysis available for 16 patients revealed that densely granulated tumors were 1,4 times more frequent than sparsely granulated somatotropinomas (43.75 vs 31.25%), whereas 8.75% were mixed mamosomatotropinomas. A rare case of mixed gangliocytoma/sparsely-granulated somatotrophinoma was recorded as well. Disease remission was observed in 30 patients (35.2%). The mean time interval from treatment to biochemical control was approximately 3 years. Fourteen patients (16,4%) had persistent disease. Three patients died due to malignancies. There was one patient with gigantism in the context of Familial Isolated pituitary adenoma (FIPA) due to AIP mutation and one patient with hyperparathyroidism and VIPoma, in the context of MEN1 syndrome. Genetic testing is ongoing.

Conclusions: Our epidemiological data does not differ from that reported in other published series. Surgery was the main treatment with a cure rate of 46,8% and SSAs the most used medication. The delay in biochemical control indicates suboptimal treatment which can have negative health effects.