An audit of treatment outcome in acromegalic patients attending our center at Bergamo, Italy

Background Acromegaly is a chronic disease impacting on morbidity and mortality. Increased mortality is reverted after the achievement of hormonal targets. The relative role of treatment options is still matter of debate. Methods A retrospective chart review was performed on all the acromegalic pati...

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Published in:Pituitary 2008, Vol.11 (1), p.1-11
Main Authors: Attanasio, Roberto, Montini, Marcella, Valota, Monia, Cortesi, Liana, Barbò, Regina, Biroli, Francesco, Tonnarelli, Giampiero, Albizzi, Mascia, Testa, Rosa Miranda, Pagani, Giorgio
Format: Article
Language:English
Subjects:
Acromegaly - etiology
Acromegaly - metabolism
Acromegaly - pathology
Acromegaly - therapy
Adenoma - complications
Adenoma - metabolism
Adenoma - pathology
Adenoma - therapy
Adolescent
Adult
Aged
Clinical Audit
Dopamine Agonists - therapeutic use
Endocrinology
Female
Human Growth Hormone - deficiency
Human Physiology
Humans
Hyperprolactinemia - etiology
Hyperprolactinemia - therapy
Hypophysectomy
Hypopituitarism - etiology
Hypopituitarism - therapy
Italy
Magnetic Resonance Imaging
Male
Medicine
Medicine & Public Health
Middle Aged
Pituitary Neoplasms - complications
Pituitary Neoplasms - metabolism
Pituitary Neoplasms - pathology
Pituitary Neoplasms - therapy
Radiotherapy, Adjuvant
Retrospective Studies
Somatostatin - analogs & derivatives
Somatostatin - therapeutic use
Time Factors
Treatment Outcome
Young Adult
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Summary:Background Acromegaly is a chronic disease impacting on morbidity and mortality. Increased mortality is reverted after the achievement of hormonal targets. The relative role of treatment options is still matter of debate. Methods A retrospective chart review was performed on all the acromegalic patients attending our center along the last 20 years. Results Data about 159 patients (83 F) were retrieved and analyzed: 18% had been lost to follow-up, while follow-up was >5 years in 79%. Growth hormone (GH) at diagnosis was 24 μg/L (median, range 3–239). Pituitary MRI showed a macro-, micro-adenoma or no lesion in 73.6, 22.9, and 3.5%, respectively. Hyperprolactinemia (hyperPRL) was present in 20.8%. Ninety-six and 29 patients had been treated by neurosurgery (NS) and irradiated (RT), respectively. Drugs had been employed in 149 patients (in 58 as the only treatment). At the last evaluation, 22% of patients were cured (hypopituitarism and GH deficiency in 6.3%), 37.1% were controlled by ongoing pharmacological treatment, 22.6% had discordant GH and Insulin-like growth factor I (IGF-I) values, and 18.2% had still active disease (median follow-up in this last group was 9 months). By evaluating the outcome with a multimodal approach, safe GH and normal IGF-I had been achieved in 78 and 63.5% of the whole series, 80.5 and 59.7% in patients submitted to NS (and adjuvantly treated with drugs), 95.8 and 91.7% in those submitted to NS + RT (and drugs as well), 70.2 and 55.2% in those treated only with drugs (increased to 82.2 and 60.9% if considering only patients treated with modern long-acting drugs). Hypopituitarism had occurred in 25, 66.6, and 13.8% in the three groups, respectively. At multivariate analysis, previous RT and NS were significant positive predictors of cure, whereas previous NS, follow-up, and year of diagnosis were significant positive predictors of control. Diabetes was a negative predictor both of cure and control. Sex, age, baseline GH levels, hyperPRL, tumor size, extrasellar extension, and invasiveness were not independent predictors of either cure or control. Conclusion This series seems to indicate that a multimodal approach can achieve control of disease in most patients.
ISSN:1386-341X
1573-7403
DOI:10.1007/s11102-007-0059-1