Acromegaly: presentation, morbidity and treatment outcomes at a single centre

Panagiotis Anagnostis (1) , Zoe Efstathiadou (2) , Stergios Polyzos (3) , Fotini Adamidou (4) , Aristidis Slavakis (5) , Michalis Sapranidis (4) , Ioannis Litsas (4) , Simoni Katergari (4) , Despina Selalmatzidou (4, 6) , Marina Kita (4)

1 2nd Propedeutic Department of Internal Medicine
2 Department of Endocrinology
3 Second Medical Clinic
4 Endocrinology Clinic
5 Department of Microbiology, Hormone Assay Laboratory
6 Endocrinology

Objective: Analysis of patients with acromegaly followed-up at a single centre, focusing on baseline characteristics, morbidity, and efficacy of treatment. Design and methods: Retrospective review of electronic medical records of acromegalics from 1987 to 2009. Results: One-hundred and fifteen patients (45 men), aged 47±14 years, with a mean follow-up of 8.8±0.8 years were studied. Twenty-five percent had micro- and 75% macroadenomas. Forty-three percent presented with visual field defects, 49% had hypertension, 25% diabetes mellitus and 35% dyslipidemia, 50% myocardial hypertrophy, 55% colon polypodiasis, 74% nodular thyroid disease and 18% adrenal masses. Surgery was performed in 79% (8% twice), followed by conventional radiotherapy in 27%. Fifty-two percent of the patients achieved remission. Disease control was reported in 65% of microadenomas and 41% of macroadenomas. Remission rates with surgery alone were 41%. Impovement of remission rates was achieved with subsequent treatment with somatostatin analogues (SSA) (53%), or conventional radiotherapy (63%). Nevertheless, pituitary reserve was compromised with the latter. SSA significantly improved outcomes in microadenomas, even as a monotherapy (remission in 89%), in contrast to macroadenomas (0%), although these agents were associated with impaired glucose metabolism and cholelithiasis in half of the cases. Conclusions: Acromegaly is associated with increased morbidity. About half of the treated patients achieved remission (2/3 of microadenomas). The best outcomes were reported for the combination of surgery with radiotherapy, in spite of a higher risk of hypopituitarism. SSA led to remission in a significant percentage of microadenomas, but were associated with increased rates of cholelithiasis and impaired glucose homeostasis.

Mots clés: Medicine

Panagiotis Anagnostis, Zoe Efstathiadou, Stergios Polyzos, Fotini Adamidou, Aristidis Slavakis, et al.. Acromegaly: presentation, morbidity and treatment outcomes at a single centre. International Journal of Clinical Practice, 2011, 65 (8), pp.896. ⟨10.1111/j.1742-1241.2011.02682.x⟩. ⟨hal-00652661⟩