ECE2013 Poster Presentations Pituitary – Clinical (<emphasis role="italic">Generously supported by IPSEN</emphasis>) (127 abstracts)
Factors Affecting Prognosis in a Series of Acromegalic Patients
Alessandra Fusco 1 , Antonio Bianchi 1 , Antonella Giampietro 1 , Donato Iacovazzo 1 , Francesca Lugli 1 , Sabrina Chiloiro 1 , Serena Piacentini 1 , Linda Tartaglione 1 , Francesco Doglietto 2 , Carmelo Anile 2 , Giulio Maira 2 & Laura De Marinis 1
1Endocrinology – Catholic University Policlinico A. Gemelli, Rome, Italy; 2Neurosurgery – Catholic University Policlinico A. Gemelli, Rome, Italy.
Introduction: The main goal in the treatment of acromegaly is achieving biochemical and tumor mass control. Therapeutic options include surgery, medical treatment and, in selected cases, radiotherapy. A GH receptor (GHR) variant that differs for the genomic retention or exclusion (d3GHR) of exon 3 is present in about 50% of general population and its presence is related to a greater sensitivity to GH.
Materials and methods: We describe a series of 118 patients diagnosed with GH-secreting pituitary adenoma (24 microadenoma, 94 macroadenoma), all submitted to surgery as first-line treatment. All patients with persistent disease after surgery have been treated with somatostatin analogues (SSA) and, among these, non-responder patients have been treated with pegvisomant. We analyzed GH and IGF-1 levels, tumor size and invasiveness, Ki-67 labeling and GHR polymorphism and correlated these findings with prognosis and response to medical treatment.
Results: Twenty-eight/118 patients (23.7%) were considered biochemically cured after surgery: these patients had more frequently microadenomas (35 vs 65%) with lower Ki-67 (1.2 vs 1.7). Among the 90 patients treated with SSA, 64 (71.1%) were biochemically controlled. Patients with disease resistant to SSA presented more frequently cavernous sinus involvement (65 vs 29%) and higher Ki-67 (2.4 vs 1.5%) compared to SSA responsive patients. Twenty-six patients have been treated with pegvisomant: 18 patients (69.3%) presented biochemical control, five patients achieved normal levels of IGF-1 with further ‘escape’ and three patients were considered not controlled. These three patients presented with higher IGF-1 levels (828 vs 439 ng/ml) and more frequent cavernous sinus involvement (100 vs 77%) compared to controlled ones and they all lacked the d3GHR polymorphism.
Conclusion: Our data show that tumor size, local invasiveness and Ki-67 labeling are all prognostic factors in pituitary GH-secreting adenomas. Moreover, lower IGF-1 levels and the presence of the d3GHR polymorphism seem to be correlated with good response to pegvisomant.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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