Endocrine Abstracts

UK National Acromegaly Register collects data on real-life clinical practice in 34 centres. We analysed all GH and IGF1 data to assess adequacy of control on medical treatment (Rx) with somatostatin analogs (SMS) and dopamine agonists (DA).

Methods: All GH records (basal, profile or GTT) in database were correlated with IGF1, Rx, surgery (TSS) and radiotherapy (RT), then processed to derive summary data for each patient and each course of Rx. GH considered controlled if ≤2 μg/l or ≤5 mU/l.

Results: GH records identified in 2572 patients (50% ♂). 23 107 patient-years of observation. 70% patients had TSS, 45% RT; 4206 courses of Rx included SMS in 40.6% and DA 41.4% of patients. Overall control of GH and IGF1 improved with time both on and off Rx, e.g. on Rx, post-TSS+RT, GH was controlled in 18/34/60% pre1990/1990’s/2000’s (IGF1 –/36/52%, both –/19/40%). Table shows responses in 2000’s to all Rx courses+to latest course of duration >360 days (last). Overall SMS were more effective than DA, but differences were less marked where this was last chosen treatment. Control achieved with octreotide LAR and lanreotide autogel was similar at last treatment, but review suggested that maximum effective dose was not always used. For DA, control on cabergoline in 2000’s was better than on bromocriptine in 1990’s, but the responsive minority who continued bromocriptine long-term in 2000’s achieved better control. For both SMS and DA, % age control of GH/IGF1 worsened substantially with increasing GH levels pre-course off-Rx. Overall, control was less good in courses on Rx before TSS/RT and better in courses after TSS/RT, probably representing a lower pre-course GH.

Conclusions: GH and IGF1 control is improving with time but control of both is still only achieved on Rx in a minority of courses. SMS and DA can both achieve control in a useful proportion of patients. Unsuccessful TSS/RT may still improve responses to subsequent medical Rx.

Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.

Funding: This work was supported, however funding details unavailable.