Endocrine Abstracts

Two nationwide surveys on acromegaly (AcroBel-1 and 2) have been performed in Belgium at an interval of five years, including centralized GH and IGF1 measurements in most patients. A normal IGF1 for age was observed in 56% of 311 vs 74% of 365 treated patients, in 2004 and 2009 respectively.

Factors responsible for this improvement were investigated. A selection bias was unlikely as the follow-up rate was higher in patients with active (83%) or medically controlled disease (71%) compared to those with surgical remission (61%).

* In 225 patients with sampling in each survey, a normal IGF1 was observed more frequently in AcroBel-2 (80%) than in AcroBel-1 (52%), due to a first or additional surgery (n=20; remission in 45%), long-term effects of previous radiotherapy (n=84), initiation or intensification of medical therapy, including pegvisomant (n=21; control in 67%).

* In 106 patients newly diagnosed and treated since the first survey, 63% had a normal IGF1. Seventy-five % had pituitary surgery and the overall remission rate (including low or suppressible GH) was 43%, but reached 50% and 68% in two centres responsible for over half of surgeries. Surgical procedures elsewhere (38 patients in18 hospitals) allowed remission in 24% (range 0–100%). Radiotherapy was used in 3 cases only. Primary medical therapy (mostly SSA, n=24) normalized IGF1 in 42%; adjuvant medical therapy (SSA or DA, n=24) in 50%, and combined treatment with SSA and pegvisomant (n=11) in 64%.

*A normal IGF1 was present in 74% of the remaining 34 patients from AcroBel-2, with diagnosis before 2003 (33 operated; 13 irradiated; 10 on medical therapy).

Conclusion: In the recent survey, a more frequent disease remission or control was observed, due to a greater use of surgery with improved outcome and to intensification of medical treatment including introduction of pegvisomant.