Cure from acromegaly after long-term medical treatment: may somatostatin receptor ligands drive complete disease disappearance in patients never treated with surgery and/or radiotherapy?

Rosa Pirchio; Auriemma Renata Simona; Chiara Altieri; Antonella Tropiano; Claudia Pivonello; Roberta Scairati; Vecchio Guendalina Del; Rosario Pivonello; Annamaria Colao

doi:10.1530/endoabs.110.P979

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Endocrine Abstracts (2025) 110 P979 | DOI: 10.1530/endoabs.110.P979

ECEESPE2025 Poster Presentations Pituitary, Neuroendocrinology and Puberty (162 abstracts)

Cure from acromegaly after long-term medical treatment: may somatostatin receptor ligands drive complete disease disappearance in patients never treated with surgery and/or radiotherapy?

Rosa Pirchio ¹ , Renata Simona Auriemma ¹ , Chiara Altieri ¹ , Antonella Tropiano ¹ , Claudia Pivonello ² , Roberta Scairati ¹ , Guendalina Del Vecchio ¹ , Rosario Pivonello ¹ & Annamaria Colao ¹

Author affiliations

¹Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Diabetologia, Andrologia e Nutrizione, Università Federico II di Napoli, Naples, Italy; ²Dipartimento di Sanità Pubblica, Università Federico II di Napoli, Naples, Italy

JOINT3359

Context: Although pituitary surgery is the first therapeutic option for acromegaly, several patients are not eligible for or refuse it. Somatostatin receptor ligands (SRLs) are the treatment of choice in these patients.

Aim: To investigate prevalence and determinants of acromegaly cure in patients treated only with SRLs medical therapy.

Methods: Monocentric retrospective study evaluating 43 acromegaly patients (22 women, 21 men, mean age 66.5±10.8 years) treated with SRLs as first line treatment (mean duration 14.1±7.1 years), never undergone to pituitary surgery or radiotherapy.

Results: Overall, 16 patients (37.2%) experienced tumour disappearance at MRI, of which 6 (37.5%) achieved also biochemical remission (IGF-I level <1xULN), with a successfully withdrawn of SRLs therapy without relapse (cure) after long-term (mean 19 years) SRLs therapy. Patients with tumour disappearance at MRI were older (P = 0.01), mainly women (P = 0.002), with smaller tumours at diagnosis (P = 0.04) as compared to those with tumour persistence. After 1 year-SRLs treatment GH levels were significantly lower (P = 0.04) and prevalence of IGF-I normalization (IGF≤1xULN, 77% vs 44%, P = 0.07) slightly higher in the former as compared to the latter. Considering cured patients, they were all women (P = 0.07), with significantly lower levels of random GH (P = 0.02) and nadir GH after OGTT (P = 0.03) harbouring smaller pituitary tumours (P = 0.09) at diagnosis as compared to patients with biochemical persistence of acromegaly. At ROC analysis, at diagnosis random GH < 6.1μg/l had 82.3% sensitivity and 80% specificity (AUC=0.802, P = 0.03) to predict acromegaly cure after long-term SRLs. Similarly, at diagnosis nadir GH < 1.93μg/l had 100% sensitivity and 66.7% specificity (AUC=0.888, P = 0.03) to predict cure after long-term SRLs. According to the median SRLs duration (13 years), patients administered with SRLs for more than 13 years had a significantly higher prevalence of tumour disappearance at MRI (47.8% vs 22.7%, P = 0.04) and a slightly higher prevalence of disease cure (21.7% vs 4.5%, P = 0.07) as compared to those with a shorter therapy length. According to the median age at the evaluation (65 years), patients >65 years had a significantly higher prevalence of tumour disappearance at MRI (47.8% vs 22.7%, P = 0.04) and a slightly higher prevalence of cure (21.7% vs 4.5%, P = 0.07) as compared to younger patients.

Conclusions: First line medical therapy is a valid option for several acromegaly patients. Among them, women and older patients with small pituitary tumours and lower levels GH at diagnosis could benefit more of this choice, being able to obtain the tumour disappearance at MRI and even the d cure.