Endocrine Abstracts

Introduction: The diagnostical and therapeutical management of GH-secreting pituitary adenomas has been modified in many aspects in the last decade, and the guidelines also have been considerably changed.

Objective: To evaluate the management of acromegaly applied in an endocrinological clinical unit from Romania, and the efficiency of different therapeutical schemes.

Materials and methods: 23 patients with acromegaly, treated and followed-up were included in this study. The positive diagnosis of GH-secreting pituitary adenoma was based on the elevated age-related IGF-1-level, suppressed GH-value >1 ng/ml during oral glucose tolerance test and conclusive hypothalamo-pituitary MRI. The applied different therapeutical schemes (surgery, drugs, radiotherapy and combination), and the efficacy of these – assessed by periodic control of IGF-1-level, suppressed GH-value and MRI – were evaluated.

Results: 78.3% of the patients had GH-secreting adenoma, the other 21.7% mixed, GH/PRL-secreting form. At diagnosis the mean suppressed GH-level was 23.2+/−6.8 ng/ml, mean IGF-1-value 784.5+/−139.4 ng/ml, mean adenoma size 17.7+/−2.8 mm. First line therapy was neurosurgery in 14 cases, medical treatment (somatostatine-analogue+/−dopamine-agonist) in six and conventional radiotherapy in three patients, out of which in five cases (21.7%, four after surgery, one after radiotherapy) a good control was achieved. The uncontrolled cases received a second therapeutical procedure, and from them other four cases (17.4%, two reinterventions, one after drug administration and one after radiotherapy) reached a good control. Finally, at eight patients combined multiple therapeutical management (surgery+drug+/−radiotherapy) was applied, and other three cases (13%) been brought under control. During long-term follow-up six patients become non-compliant, and they did not return to reevaluations.

Conclusion: From all the 23 subjects in 52.1% an optimal therapeutic control was achieved with all the applied treatment schemes. Acromegaly could be controlled by monotherapy, mainly neurosurgery in 21.7%, by double treatment scheme in an other 17.4% and by multiple therapeutical combinations in 13% of the cases.