Endocrine Abstracts

JOINT1665

Introduction: Acromegaly is a condition primarily treated with surgery.

Objective: To describe the diagnostic and therapeutic evolution of acromegaly patients over the past 30 years in a tertiary hospital.

Material and Methods: A retrospective observational study of patients diagnosed with acromegaly between 1993 and 2023 at the Hospital Clínico Universitario de Valladolid, Spain. Clinical, radiological, and laboratory characteristics were collected at diagnosis, in the immediate postoperative period, and after one year, as well as histopathological findings and treatment details.

Results: A total of 34 patients were analyzed, 55.9% of whom were women, with a mean age of 59.7 (14.2) years. The main clinical presentations were hormonal excess (62.5%), compressive symptoms (20.8%), or both (16.7%). One case of pituitary apoplexy was recorded, and two patients (3%) were diagnosed with MEN-1. The main associated comorbidities are shown in Figure 1. MRI was the first radiological test in 90.9% of cases, identifying macroadenomas in 80.8%. Tumors extended suprasellarly in 22.2%, laterally in 7.4%, and demonstrated invasive criteria in 7.4% (more than two locations). Surgery was performed in 30 patients, with the endoscopic approach (63.6%) being the most common, followed by direct endonasal (27.3%). The mean tumor volume reduction was 88.1%. Hormonally, a significant reduction in IGF-1 levels (563.4 (297.6) vs. 263.2 (206.9); P <0.01) and a trend toward GH reduction (20.6 (25.3) vs. 5.3 (7.6); P = 0.057) were observed one year post-surgery. Immunohistochemical analysis was performed in 38.2% of cases, revealing 42.9% prolactin co-secretion, and two cases of GH, PRL, and ACTH co-secretion. Disease persistence was observed in 63.3% of patients, and radiotherapy was administered to 11 patients. Pharmacological treatment was initiated in 56.7% of patients at diagnosis, 16 patients in the immediate postoperative period, and 19 in the late postoperative period. One year post-surgery, 29.4% were receiving Lanreotide, 8.8% Octreotide, one patient Pegvisomant, and one Pasireotide. Three patients received concomitant dopamine agonists. Corticosteroid replacement therapy was required in 51.7% of patients in the early postoperative period and 23.3% in the late postoperative period.

Conclusion: Surgery remains the primary treatment for acromegaly, achieving high tumor volume reduction and a significant decrease in IGF-1 levels, although disease persistence remains frequent (63.3%). More than half of the patients required postoperative pharmacological treatment, and some underwent radiotherapy. These findings highlight the need for a multidisciplinary approach to optimize disease control.