Endocrine Abstracts

Introduction: Treatment of patients with acromegaly is complex, including surgery, pharmacotherapy and radiotherapy. The objective was to describe comorbidities and treatment patterns among patients with acromegaly in Sweden.

Methods: Population-based study including all patients with a first diagnosis of acromegaly due to a pituitary adenoma in Sweden between 1 Jul 2005 and 31 Dec 2013. Data was obtained via linkage of the National Patient Register, Swedish Prescribed Drug Register and Cause of Death Register.

Results: Predefined selection criteria identified 358 patients (48% men, mean age at diagnosis 50.0 [SD 15.3] years). Eighty-one percent had at least one comorbidity, which was 88% among patients diagnosed before 2010 and 73% if diagnosed ≥2010. Hypertension (40%), neoplasms outside the pituitary gland (30%), hypopituitarism (22%) and diabetes mellitus (17%) were the most common comorbidities. First-line treatment was initiated on average 3.7 (S.D. 6.9) months after diagnosis; 16% received no treatment for acromegaly during the follow-up period. Mean follow-up time from diagnosis to death or 31 Dec 2013 was 4.2 (S.D. 2.5) years. Among the 301 patients who received treatment, the most common first-line treatments were surgery (60%), somatostatin analogues (SSA) (21%) and dopamine agonists (14%). After primary surgical treatment, 63% received no second-line treatment during follow-up, while 24% received SSA initiated on average 14.0 (S.D. 14.7) months after surgery. The most common treatment after first-line SSA was surgery (58%), performed on average 5.3 (S.D. 5.4) months after SSA initiation. Overall, 10% had received growth hormone receptor antagonists. Radiation therapy was performed for 16% and 8% if diagnosed before 2010 and ≥2010, respectively.

Conclusions: Comorbidity in patients with acromegaly is very high. The most common first-line treatment in acromegalic patients in Sweden was surgery, with the majority not receiving any second-line treatment. SSA was the second most common first-line treatment, often followed by second-line surgery.