Endocrine Abstracts

Background: Transsphenoidal surgery of pituitary adenoma is often first-line therapy for patients with acromegaly. Pharmacotherapy and/or radiotherapy are applied when surgery fails to achieve good disease control, or when surgery is impossible or contraindicated. In this study, we report the results of therapies, rates of cure and hypophyseal insufficiency in our acromegalic patients.

Methods and results: Medical files of the 62 patients who were followed from 1984 to 2013. SPSS-19 version was used for statistical analysis. Descriptive and χ² tests were used, and results expressed as mean±S.E.M. Microadenoma was detected in 8 (12.9%) and macroadenoma in 53 (85.5%) of the patients. Among the transsphenoidally operated 27 (43.5%) patients, 4 (14.8%) had postoperative remission, 10 (37%) developed with one or more hormonal defficiency, 1 (3.3%) developed diabetes insipidus. Among the transcranially operated 20 (32.3%) patients, 2 (10%) were postoperatively cured, 17 (85%) developed hypophyseal insufficiency; none of them developed diabetes insipidus. Four patients were operated transcranially due to recurrence after transsphenoidal operation; one of them developed hypothyroidism.

During the postoperatif follow-up, 5 (8.1%) patients had conventional radiotherapy; among whom one patient had remission and one had empty sella. Gamma-knife radiotherapy was applied to 15 (24%) patients; among whom one had remission and three had empty sella; eight of these 15 patients had residue; seven of these eight patients had medical therapy. Two of these 15 patients had residue and hypophyseal insufficiency, one of these 15 patients had recurrence. In addition to six patients with are after surgical therapy, four patients had cure after radiotherapy and/or pharmacotherapy (complet cure in 10 (16%) patients).

Thirty (61.5%) of 52 patients treated with ocreotid had GH levels below 2.5 ng/ml and IGF1 levels within the normal range (for age and gender). Two (40%) of five patients treated with lanreotid had GH levels below 2.5 ng/ml and IGF1 levels within the normal range. In assesment of all the patients, 23 (37.1%) patients GH levels above 2.5 ng/ml, 38 (58.1%) patients had GH levels below 2.5 ng/ml. Initially, diabetes mellitus was present in 22 (35%) patients, in the last follow-up was reduced number of diabetic patients (18 (29%)).

Conclusion: Our success rate in acromegaly treatment has been found to be lower than the literature. We think that early diagnosis, experienced hypophyseal surgeons and further development with regard to medical therapy are required.