Endocrine Abstracts

Nepal has limited data on acromegaly patients. We did a retrospective study of acromegaly patients who were diagnosed in our center or were referred to our center. We included 10 patients of acromegaly who presented in our center from January 2018 to December 2022. Four (40%) were males and six (60%) were females. Their mean age was 38.70 +/- 6.51 years, ranging from 31 to 50 years. The mean BMI was 26.13+/-1.77 kg/m². The most common presenting symptom was joint pain (90%) followed by headache and peripheral neuropathy (40% each). Three patients (30%) patients had visual problems with visual defects. All patients had acral enlargement, prominent supraorbital ridge and prognathism. Increased sweating was seen in 3 patients (30%). Four (66.66%) out of six female patients had menstrual abnormalities; one forty-four years old patient had amenorrhea for two years and another female of thirty-one years of age had amenorrhea for eight months. Hypertension was seen in three (30%) patients and diabetes was seen in seven (70%) patients. One (10%) patient had hypothyroidism. All patients had elevated basal GH and IGF1. Mean basal GH was 48.78+/- 43.67 ng/ml, ranging from 6.36 to 160 ng/ml with median of 44.29 ng/ml. Mean IGF-1 was 515.25+- 316.03 ng/ml ranging from 117 to 954 ng/ml with median of 522.65 ng/ml. Hyperprolactinemia was seen in two (20%) patients while secondary hypogonadism was seen in one (10%) patient and secondary hypercortisolism was seen in one (10%) patient. One (10%) patient had pituitary microadenoma whereas nine (90%) patients had pituitary macroadenoma. Seven patients (70%) underwent surgery to remove pituitary adenoma and three patient (30%) refused surgery. Out of seven patients who had surgery, six patients (60%) underwent endoscopic trans-sphenoidal surgery and one (10%) patient underwent transcranial pituitary adenectomy. Post operatively one patient (10%) developed diabetes insipidus, one (10%) patient developed third cranial nerve palsy and hypocortisolism. The mean GH of seven patients who underwent surgery was 10.22+/- 7.73 ng/ml and IGF-1 was 398.90+/-268.35 ng/ml ranging from 143 to 879 ng/ml. None of the patients had remission. Three (30%) patients received second line treatment. Among them two (20%) patients underwent radiotherapy; 1(10%) received EBRT (External beam radiation therapy) and 1(10%) underwent gamma knife surgery. One patient (10%) received Sandostatin (Octreotide LAR). One (10%) of our patient had to undergo resurgery- transphenoidal pituitary surgery.