Endocrine Abstracts

Background: Acromegaly is a rare severe disease which, untreated, leads to increased cardiovascular and respiratory morbidity and mortality. Pituitary surgery is the first-line therapy, and medical treatment (somatostatin receptor ligands SRLs, dopamine agonists DA, and GH receptor antagonists GHRAs) is indicated for persistent disease. While selected patients are treated with DA and GHRAs, SRLs remain the mainstay of acromegaly therapy.

Objective: The aim of this study is to report our results regarding medical therapy in patients with persistent acromegaly after surgery and/ or radiotherapy.

Patients and methods: We retrospectively reviewed 59 patients (33 women and 26 men), diagnosed with acromegaly, mean age at diagnosis 44.93±13.57 years, managed between 2009 and 2016 in our department. Controlled disease was defined as normal IGF-1 for age and sex and random GH<1 ng/ml.

Results: 19 patients, cured after surgery or radiotherapy were excluded. 31 patients received medical therapy and 9 were lost during follow up. 26 were treated with SRLs alone or in combination therapy, 3 received DA alone, one DA and GHRAs and one GHRAs alone. SRLs were used as monotherapy in 13 (50%), tritherapy in 3 (11.5%), in combination with DA in 9 patients (34.6%) and with GHRAs in one (3.8%). IGF-1 normalization was achieved in 10 patients (32%), 7 receiving SRLs (five in monotherapy, one with DA and one in tritherapy), two DA alone and 1 with GHRAs alone. Random GH<1 ng/ml was achieved in six patients (19.3%) (three in monotherapy SRLs, two in association with DA and one on DA alone). Controlled disease was found in five patients (16.1%) (three receiving monotherapy with SRLs, one with tritherapy and one with GHRAs).

Conclusion: In long-term follow-up, almost 40% patients got full control of acromegaly, but only 20% of them on medical treatment. Medical approach in acromegaly should be individualized, combination therapy could provide additional biochemical control, but new therapies should be implemented.