Endocrine Abstracts

Introduction: Guidelines suggest definition for cure in acromegaly is to achieve a nadir growth hormone (GH) <2 mU/l during a growth hormone suppression test and a normal IGF-1 level (Gustina 2000). Following an earlier retrospective audit (Brown et al. 2002), showing limited achieved cure success, we re-audited our patients.

Methods: All patients with acromegaly were invited to undergo growth hormone suppression test and IGF-1measurement over 18 months.

Results: There were 51 cases of acromegaly compared to 58 in the 2002 audit. Five patients declined participation; one patient had no IGF-1 measurements. Thus 45 patients were in present audit and 43 patients in earlier audit.

In present audit 29 (65%) patients achieved ‘cure’ (by above criteria) compared to 19 (44%) in 2002 audit.

Only 5 (11%) patients had elevated GH and IGF-1 compared to 12 (28%) 2002. Of those one was newly diagnosed, two had other medical conditions complicating treatment, two were having medication titrated upwards.

We noted discordance between GH and IGF-1 in 11 patients (24%). Of these four were having medication titration. One patient vomited during test only reaching a nadir of 2.3 mU/l. Upper limit of IGF-1 range drops dramatically at aged 60; four patients (ages 69–79) had IGF-1 level just above normal matched for age range. Two patients were not keen to increase medical therapy.

Twenty-one (47%) of recently audited patients were on active medical treatment compared to 32 (57% full cohort) in 2002. Medical intervention was somatostatin analogues −57% patients and dopamine agonists- 43% patients. Of those 21 patients, 10 had received surgery & DXT; three had surgery alone.

Conclusions: More sensitive assays and more effective medical treatment have led to stricter criteria for cure in acromegaly. This audit shows we have raised our cure rate by 21%. Discordance remains a problem in 36% of our patients.