Abstract
OBJECTIVE: To evaluate the therapeutic trends and long-term outcome of treatment modalities for acromegaly in our center over a 40-year period. Design: We retrospectively studied 321 acromegalic patients (145 males/176 females) diagnosed and treated from the 1970s until September 2013. Patients were divided into two subgroups: group A consisted of 166 patients diagnosed before 1990 and group B of 155 patients diagnosed after 1990. Outcome was assessed with GH (random and/or post OGTT) and IGF1 measurements. RESULTS: More group A than group B patients were submitted to radiotherapy (57.8% vs 16.8% patients, respectively, p <0.001). In contrast, more patients of group B were offered surgery (70.3% vs 42.1% in group A, p <0.001) and/or medical treatment (70.3% vs 23.4% in group A, p <0.001). At latest follow-up, 68.4 % of patients in group B achieved GH <2.5 µg/l after treatment vs 39.8% in group A, p=0.001, 46.9% of patients in group B achieved GH <1 µg/l vs 20.3% in group A, p=0.001 and 47.1% of patients in group B achieved during OGTT GH nadir <0.4 µg/l vs 18.6% in group A, p=0.001. CONCLUSIONS: Transsphenoidal resection and medical treatment resulted in improved outcome in acromegalic patients treated over the last 20 years. However, the disease still remains uncontrolled in a considerable number of patients.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Melmed S, 2009 Acromegaly: pathogenesis and treatment. J Clin Invest 119: 3189–3202.
Sesmilo G, 2013 Epidemiology of acromegaly in Spain. Endocrinol Nutr 60: 470–474.
Fieffe S, Morange I, Petrossians P, et al, 2011 Diabetes in acromegaly, prevalence, risk factors and evolution: data from the French acromegaly registry. Eur J Endocrinol 164: 877–884.
Petrossians P, Tichomirowa MA, Stevenaert A, Martion D, Daly AF, Beckers A, 2012 The liege acromegaly survey (LAS); a new software tool for the study of acromegaly. Ann Endocrinol Paris 73: 193–201.
Holdaway IM, Rajassorya C, 1999 Epidemiology of acromegaly. Pituitary 2: 29–41.
Daly AF, Rixhon M, Adam C, Dempegioti A, Tichomirowa MA, Beckers A, 2006 High prevalence of pituitary adenomas: a cross-sectional study in the provence of Liege, Belgium. J Clin Endocrinol Metab 91: 4769–4775.
Katznelson L, Raws ERJr, Melmed S, et al, 2014 Acromegaly: An endocrine society clinical practice guideline. J Clin Endocrinol Metab 99: 3933–3951.
Drange MR, Fram MR, Herman-Bonert V, Melmed S, 2000 Pituitary tumor registry: A novel clinical resource. J Clin Endocrinol Metab 85: 168–174.
Holdaway IM, Rajassorya RC, Gamble GD, 2004 Factors influencing mortality in acromegaly. J Clin Endocrinol Metab 89: 667–674.
Kauppinen-Mäkelin R, Sane T, Reunanen A, et al, 2005 A nationwide survey of mortality in acromegaly. J Clin Endocrinol Metab 90: 4081–4086.
Vallette S, Ezzat S, Chik C, et al, 2013 Emerging trends in the diagnosis and treatment of acromegaly in Canada. Clin Endocrinol (Oxf) 79: 79–85.
Bex M, Abs R, T’Sjoen G, et al, 2007 AcroBel — the Belgian registry on acromegaly: a survey of the ‘real-life’ outcome in 418 acromegalic subjects. Eur J Endocrinol 157: 399–409.
Schofl C, Franz H, Grussendorf M, et al, 2012 Long-term outcome in patients with acromegaly: analysis of 1344 patients from the German Acromegaly Register. Eur J Endocrinol 168: 39–47.
Kwon O, Song YD, Kim SY, et al, 2013 Nationwide survey of acromegaly in South Korea. Clin Endocrinol (Oxf) 78: 577–585.
Arosio M, Reimondo G, Malchiodi E, et al, 2012 Predictors of morbidity and mortality in acromegaly: an Italian survey. Eur J Endocrinol 167: 189–198.
Mestron A, Webb SM, Astorga R, et al, 2004 Epidemiology, clinical characteristics, outcome, morbidity and mortality in acromegaly based on the Spanish Acromegaly Registry. Eur J Endocrinol 151: 439–446.
Sesmilo G, Gaztambide S, Venegas E, et al, 2013 Changes in acromegaly treatment over four decades in Spain: analysis of the Spanish Acromegaly Registry (REA). Pituitary 16: 115–121.
Cuevas-Ramos D, Carmichael JD, Cooper O, et al, 2015 A structural and functional acromegaly classification. J Clin Endocrinol Metab 100: 122–131.
Jane Jr, JA, Starke RM, Elzoghby MA, et al, 2011 Endoscopic Transsphenoidal Surgery for Acromegaly: Remission Using Modern Criteria, Complications, and Predictors of Outcome. J Clin Endocrinol Metab 96: 1–9.
Thalassinos NC, Tsagarakis S, Ioannides G, et al, 1998 Megavoltage pituitary irradiation lowers but seldom leads to safe GH levels in acromegaly: a long-term follow-up study. Eur J Endocrino 138: 160–163.
Jenkins PJ, Bates P, Carson MN, et al, 2006 Conventional pituitary irradiation is effective in lowering serum growth hormone and insulin-like growth factor-I in patients with acromegaly. J Clin Endocrinol Metab 91: 1239–1245.
Abu Dabrh AM, Mohammed K, Asi N, et al, 2014 Surgical Interventions and Medical Treatments in Treatment-Naïve Patients With Acromegaly: Systematic Review and Meta-Analysis. J Clin Endocrinol Metab 99: 4003–4014.
Mercado M, Borges F, Bouterfa H, et al, 2007 A prospective, multicentre study to investigate the efficacy, safety and tolerability of octreotide LAR (long-acting repeatable octreotide) in the primary therapy of patients with acromegaly. Clin Endocrinol (Oxf) 66: 659–678.
Carmichael J, Bonert VS, Nuno M, et al, 2014 Clinical Trial Methodology Impact on Reported Biochemical Efficacy Rates of Somatostatin Receptor Ligand Treatments: A Meta-Analysis. J Clin Endocrinol Metab 99: 1825–1833.
Cozzi R, Montini M, Attanasio R, et al, 2006 Primary treatment of acromegaly with octreotide LAR: a long-term (up to nine years) prospective study of its efficacy in the control of disease activity and tumor shrinkage. J Clin Endocrinol Metab 91: 1397–1403.
Cozzi R, Attanasio R, Montini M, et al, 2003 Four-Year Treatment with Octreotide-Long-Acting Repeatable in 110 Acromegalic Patients: Predictive Value of Short-Term Results by ROC analysis. J Clin Endocrinol Metab 88: 3090–3098.
Neggers SJ, Franck SE, de Rooij FW, et al, 2014 Long-term efficacy and safety of pegvisomant in combination with long-acting somatostatin analogs in acromegaly. J Clin Endocrinol Metab 99: 3644–3652.
Higham CE, Chung TT, Lawrance J, et al, 2009 Long-term experience of pegvisomant therapy as a treatment for acromegaly. Clin Endocrinol (Oxf) 71: 86–91.
Freda PU, Katznelson L, van der Lely AJ, et al, 2005 Long-acting somatostatin analog therapy of acromegaly: a meta-analysis. J Clin Endocrinol Metab 90: 4465–4473.
Bevan JS, 2005 Clinical review: the antitumoral effects of somatostatin analog therapy in acromegaly. J Clin Endocrinol Metab 90: 1856–1863.
Resmini E, Dadati P, Ravetti JL, et al, 2007 Rapid pituitary tumor shrinkage with dissociation between antiproliferative and antisecretory effects of a long-acting octreotide in an acromegalic patient. J Clin Endocrinol Metab 92: 1592–1599.
Giustina A, Mazziotti G, Torri V, et al, 2012 Meta-analysis on the effects of octreotide on tumor mass in acromegaly. PLoS One 7: e36411.
Caron PJ, Bevan JS, Petersenn S, et al, 2014 Tumor Shrinkage With Lanreotide Autogel 120 mg as Primary Therapy in Acromegaly: Results of a Prospective Multicenter Clinical Trial. J Clin Endocrinol Metab 99: 1282–1290.
Amato G, Mazziotti G, Rotondi M, et al, 2002 Long-term effects of lanreotide SR and octreotide LAR on tumour shrinkage and GH hypersecretion in patients with previously untreated acromegaly. Clin Endocrinol (Oxf) 56: 65–71.
Plöckinger U, Reichel M, Fett U, Saeger W, Quabbe HJ, 1994 Preoperative octreotide treatment of growth hormone-secreting and clinically nonfunctioning pituitary macroadenomas: effect on tumor volume and lack of correlation with immunohistochemistry and somatostatin receptor scintigraphy. J Clin Endocrinol Metab 79: 1416–1423.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Karapanou, O., Tzanela, M., Christoforaki, M. et al. Therapeutic trends and outcome of acromegaly: a single center experience over a 40-year period. Hormones 15, 368–376 (2016). https://doi.org/10.14310/horm.2002.1680
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.14310/horm.2002.1680