Endocrine Abstracts

Introduction: The purpose of this study was to evaluate treatment options and effectiveness in patients with acromegaly.

Methods: The study involved retrospective data collection from charts of 75 patients with acromegaly who was treated at Vilnius University Hospital Santaros klinikos.

Results: Patient population consisted of 21 males (28%) and 54 females (72%), mean age at diagnosis 52 ± 13 years. In most of the cases, macroadenoma was diagnosed (macroadenoma 68.75% vs microadenoma 31.25%). Based on GH and IGF-1 levels, disease control was achieved in 33 out of 73 (45.2%) patients (data of 2 patients is missing). Transsphenoidal surgery was performed in 49 (67.1%) patients of which disease control was achieved in 27 (57.4%): in 13 out of 19 patients without additional treatment, in 8 out of 22 with additional medical therapy and in 6 out of 7 with additional medical therapy and radiotherapy. Permanent postoperative hypopituitarism was observed in 9 (18.4%) patients. Disease control was achieved in 6 out of 24 (25%) patients who refused or had contraindications to surgical treatment. Medical therapy (somatostatin analogues (SSA), dopamine agonists (DA)) was applied in 38 of our patients: 27 patients received first-generation SSA, 3 patients received Pasireotide, 3 patients DA and 5 patients SSA with DA (control was achieved in 8 (29.6%), 1 (33.3%), 2 (66.7%) and 1 (20.0%) respectively). High-dose medical therapy are now receiving 18 out of 38 patients and in a majority (94.4%) of them complete disease control was not achieved.

Conclusions: Surgical treatment is the first-line treatment option of acromegaly, although many patients refuse or have contraindications for the surgery. Primary medical therapy with SSA ± DA leads to disease control in only 25% of the patients despite availability of high-dose first generation SSAs and pasireotide. The best outcomes of acromegaly treatment were observed when treatment combinations were chosen – surgery with secondary medical treatment ± radiotherapy.