Endocrine Abstracts

Introduction: Even Though resection via transsphenoidal surgery is the optimal primary treatment for growth hormone (GH) secreting pituitary adenomas, medical therapy must also be considered when biochemical control after surgery is not achieved. The aim of our study was to describe the cure rates of acromegaly patients after different lines of therapy.

Methods: A retrospective study (1971–2022) of 89 patients diagnosed with acromegaly was conducted. Age, sex, radiological characteristics of the pituitary adenoma, hormonal evaluation and response to different therapy lines were the studied. SPSS Statistics software was used for the analysis.

Results: A total of 89 patients were reviewed. The mean age at diagnosis was 51±10.2 years, 57.3% were females. The mean maximal tumor diameter was 1.7±0.65 cm, and up to 67.1% were macroadenoma. The MRI described cavernous sinus invasion in 19% of microadenoma and in 48% of macroadenoma. A total of 17 (19.8%) patients showed hyper-intense adenoma on T2- weighted MRI sequences, 13 (15.1%) are described as hypo-intense whereas 39(45.3%) appear to be isointense. Chiasmatic involvement was observed in 24 (28.9%). Basal insulin-like growth factor type 1 (IGF-1) above the upper limit of normal (ULN) and growth hormone (GH) levels after an oral glucose load (OGTT) (mean ± S.D.) were 678±265 and 8.5 (1.5–20.7) ng/ml, respectively. Out of 89, 78 patients (80.9%) underwent surgery as primary treatment, the remaining cases required first-line medical treatment due to a rejection of surgical treatment or non-suitability because of high surgical risk. The histopathology report described proliferative marker Ki-67 ≤ 3% in 45 patients (Ki >3% in 10 patients). After surgical intervention, 74 patients continued in active followed up. Forty-seven of them (63.5%) were in disease remission (GH nadir on OGTT <0.4 ng/dl). Second line therapy was used for the 27 patients with persistent disease activity despite surgical resection. Five of them were treated with dopaminergic agonist another 16 with somatostatin receptors ligands (SRL), 2 with pegvisomant and the remaining 4 cases required a combination of SRL and cabergoline. A total of 24 patients (93%) showed IGF1 levels in normal range (5, 15, 2 and 2 for each therapy respectively).

Conclusion: Surgical intervention as the first line of treatment for patients with acromegaly achieves high cure rates. In those cases in which the disease is not cured, the available pharmacological treatments allow us to achieve disease control in practically all patients.