Endocrine Abstracts

Introduction

Although surgical treatment of acromegaly is the treatment of choice in most patients, a wide therapeutic arsenal is available. Medical treatment can be indicated as primary treatment, complementary and even as pre-operative treatment.

Objectives

To determine the prevalence of uncured acromegaly and the prevalence of controlled disease within this group. To clinically, biochemically and histologically characterize uncured acromegalics. To analyze the predictive factors for non-cure in acromegaly.

Material and methods

Retrospective study of adult patients with uncured acromegaly under follow-up in the Neuroendocrinology Unit of a tertiary hospital in Madrid during the period 2000–2020. Non-cure criteria were considered: elevated IGF-1 according to age and sex and random GH ≥ 1µg/l and/or post OGTT 75 gr ≥ 0.4 or ≥ 1µg/l, according to the analytical method used. Controlled disease criteria were considered: normal IGF-1 according to age and sex and random GH < 2.5µg/l. Continuous variables were expressed as mean and standard deviation and categorical variables as absolute values and percentages. Univariate and multivariate logistic regression models were analyzed to determine predictors of non-healing, significant P < 0.05.

Results

Of 97 adult patients with acromegaly, 52.7% (n = 51) did not meet cure criteria, of these, 46.5% (n = 40) after sphenoidal surgery. 56.9% were women, age 61 ± 18.7 years, BMI 28.4 ± 5 kg/m², IGF-1 956.2 ± 677.1µg/l and GH 30.0 ± 42.7µg/l. 75% presented pituitary macroadenoma, 82.1% with extrasellar extension. 50% were somatotropinomas and the rest secreted GH+PRL (35%), GH + PRL + TSH (10%) and PRL (5%). 84.6% and 41.7% had positivity for Ki67 (72.7% < 3% and 27.3% 3–10%) and p53, respectively. 94.1% (n = 48) received medical treatment, 20 patients in monotherapy (12 SSAs, 7 carbergoline and 1 pegvisomant) and 28 patients in combined therapy (12 SSAs + cabergoline, 6 SSAs + pegvisomant, 1 pegvisomant + cabergoline and 9 triple therapy). In total, 92% met criteria for controlled disease, 100% of those treated with SSA and pegvisomant in monotherapy and 85.7% with cabergoline in monotherapy (directly proportional to the dose), and 89.2% of those receiving combined therapy. 35.7% also received RT, with 93.3% controlling the disease. Predictive factors of non-cure after surgery were pituitary macroadenoma, initial GH and IGF-1 values and co-secretion of GH + PRL and GH + PRL + TSH.

Conclusions

The surgical remission rate exceeds 50%. Almost all patients who are not cured achieve control of the disease with pharmacological treatment. Medical treatment should be individualized according to the presence of pituitary macroadenoma, co-secreting hormone pituitary adenomas, initial levels of GH and IGF-1 and the clinical and hormonal evolution of the patient.