Disease activity drop-off in elderly patients with active acromegaly over a median follow-up period of ten years: a longitudinal, restrospective study

Alessio Bellelli; Chiara Diazzi; Vincentis Sara De; Vincenzo Rochira

doi:10.1530/endoabs.110.EP728

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Endocrine Abstracts (2025) 110 EP728 | DOI: 10.1530/endoabs.110.EP728

ECEESPE2025 ePoster Presentations Growth Axis and Syndromes (132 abstracts)

Disease activity drop-off in elderly patients with active acromegaly over a median follow-up period of ten years: a longitudinal, restrospective study

Alessio Bellelli ¹ , Chiara Diazzi ¹ , Sara De Vincentis ² & Vincenzo Rochira ³

Author affiliations

¹Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy, Modena, Italy; ²Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy; ³Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy

JOINT3849

Introduction: GH-IGF-1 axis activity declines with aging. Acromegaly. Central GH regulation is retained at least in part in acromegaly, despite autonomous GH secretion. However, changes of GH-secreting tumor function in the elderly remain unclear.

AIM: To investigate GH-IGF-1 axis functional changes overtime in GH-secreting adenomas in terms of acromegaly disease activity in relation to advancing age.

Methods: A retrospective, longitudinal study involving 31 adult patients with active acromegaly was conducted at a single centre over an extended follow-up period from February 2008 to October 2024. At each visit, comprehensive patient data were collected including acromegaly-specific medical history, detailed medication history (start date, duration, dosage, and withdrawal information), biochemical parameters (from a single laboratory) and comorbidities. Acromegaly control was assessed using IGF-1 ULN (ULN1) alone or in relation to ongoing therapy as a product of each [for cabergoline (cab), octreotide (octr), lanreotide (lan), pegvisomant (peg)] drugs daily dose and the corresponding ULN value (ULN1*cab dose, ULN1*octr dose, ULN1*lan dose, ULN1*peg dose). This analysis was also repeated for IGFBP-3 (ULN2) and the relative product based on drug daily dose (ULN2*cab dose, ULN2*octr dose, ULN2*lan dose, ULN2*peg dose).

Results: Serum IGF-1 (p < 0.001), IGFBP-3 (p < 0.001), ULN1 (p < 0.001), and ULN2 (p < 0.001) trajectories overtime were inversely related to the time to disease relapse/onset. The inverse trajectory over time was particularly evident for ULN1*cab dose (p < 0.001), ULN1*octr dose (p < 0.001), and ULN1*peg dose (p < 0.001). The same trajectories showed a similar trend for ULN2*cab dose and ULN2*peg dose. The temporal trajectories of ULN1*lan dose (P =0.278) and ULN2*lan dose did not change significantly over time (P = 0.409). The ULN2*octr dose trajectory overtime showed a trend in reduction but did not reach statistical significance (P =0.064).

Conclusion: This study suggests that disease activity decreases in older acromegalic patients by the progressive evolution towards a less aggressive disease. Significantly, this research demonstrates as novel observation a decline in the ULN of IGF-1 (ULN1) and IGFBP-3 (ULN2) over time, even after adjusting for daily medication dosage. Improving knowledge on the natural history of acromegaly disease in terms of disease activity modifications during aging and long-term follow-up will enable optimizing therapeutic decisions and drug dosage titration finally minimizing the risk of overtreatment.