SFEBES2018 Poster Presentations Neuroendocrinology and pituitary (25 abstracts)
A single-centre audit of treatment outcomes in 185 acromegaly patients under regular follow-up
Sardar Muhammad Shoaib Khan 1 , Laura Mola 2 , Leticia Perez-Fernandez 3 , Alex Vincent 1 , Ashley Grossman 1 , Simon Cudlip 1 , Bahram Jafar-Mohammadi 1 & Aparna Pal 1
1Oxford University Hospitals, Oxford, UK; 212 de Octubre Hospital, Madrid, Spain; 3Hospital General Universitario de Castellón, Castellón de la Plana, Spain.
Transsphenoidal adenomectomy (TSA) is the recommended primary therapy in most patients with acromegaly and results in remission for majority of microadenomas and a proportion of macroadenomas depending on extent of surgically accessible disease. Acromegaly is associated with significant mortality and morbidity, hence a combination of treatment modalities may be needed to achieve disease control.
Methods: A retrospective casenotes review was conducted and management audited against the 2014 Endocrine Society guidelines. Patients were identified from the departmental database and clinic. Post-operative cure, and disease control, were defined as normal age- and sex-adjusted IGF-1, and either a random serum GH<1 μg/L or GH nadir<1 μg/L on OGTT.
Results: Data were collected on 185 patients currently attending clinic (Males 52.7%) with mean follow-up 154 months (range 2–587). Mean age at diagnosis was 44 years (59% macroadenomas; 30% microadenomas; 11% imaging not available): 167 (90%) were treated with TSA leading to cure in 62% (29/47) of microadenomas and 33% (33/101) of macroadenomas. Overall, 131/185 (71%) patients are controlled: 62 (33%) patients with surgery alone; 34 (18%) with surgery and pharmacotherapy (SSA and/or cabergoline and/or pegvisomant); 14 (7.6%) with surgery and radiotherapy; 15 (8%) with surgery, radiotherapy and pharmacotherapy; 10 (5.4%) patients with pharmacotherapy alone; 2 (1%) with radiotherapy alone. A further 28 patients (15%) have IGF-1/GH discordance with either normal IGF-1 (21) or GH<1 (7). In 12% of patients (8/65) who were initially cured after TSA, recurrence occurred after a mean duration of 7 years.
Conclusion: Our surgical remission rates are comparable to other published series. The 71% control with multimodal therapy compares favourably with other series. A recurrence rate of 12% emphasises the importance of long term follow-up. It is important to prioritise patients with uncontrolled acromegaly to reassess scope for treatment escalation.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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