BES2005 Poster Presentations Endocrine tumours and neoplasia (46 abstracts)
External pituitary irradiation normalizes serum insulin like growth factor-1 levels in a significant percentage of patients with acromegaly
K Mullan 1 , WP Abram 3 , SJ Hunter 1 , DR McCance 1 , M McConnell 1 , H Leslie 2 , C Sanabria 1 , B Sheridan 2 & AB Atkinson 1
1Regional Centre for Endocrinology and Diabetes, RGHT, Belfast, Northern Ireland; 2Regional Endocrine Laboratory, RGHT, Belfast; 3Department of Clinical Oncology GPHCT, Belfast, Northern Ireland.
It is well established that external pituitary irradiation (EPI) effectively reduces serum growth hormone levels in acromegaly. However the effect of EPI in normalising serum insulin like growth factor-1 levels (IGF-1) remains disputed. We studied 60 patients between 1964 and 2004 who received EPI for acromegaly: 22 women, 38 men; mean age at diagnosis 38.5 years (range 14-68). Pituitary surgery was carried out in 50/60 patients; in 47 patients EPI was given after their last surgery. Patients received 4500-5000cGy in 30 fractions over 6 weeks. IGF-1 levels, available from 1992 onwards, were measured by various immunoassays; results were correlated with their respective age - related reference ranges. Somatostatin analogues, bromocriptine and cabergoline were used as adjunctive therapy. After EPI, the number with persistently normal IGF-1, free of adjunctive treatment for at least 6 months, were 5 out of 44 patients by 3 years (in whom IGF-1 assay was available), 9 out of 46 patients by 5 years, and 18 out of 49 patients by 10 years. At greater than 10 years we identified 9 further patients making a current total of 27 /60 patients. Additional hormone replacement treatment was required in 20 /53 patients in whom this information was available.
In summary, at this centre, we found a significant number of patients (27/60) had persistently normal IGF-1, free of adjunctive treatment for at least 6 months, after external pituitary irradiation for acromegaly. The side-effect most limiting its use is the development of new hypopituitarism in a substantial subset.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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