ECE2023 Poster Presentations Pituitary and Neuroendocrinology (123 abstracts)
Acromegaly in the elderly: additional challenges in timely recognizing
Sandra Pekic Djurdjevic 1,2 , Marko Stojanovic 1,2 , Mirjana Doknic 1,2 , Dragana Miljic 1,2 , Toplica Milojevic 3 , Mihailo Milicevic 2,3 , Aleksandar Stanimirovic 3 , Vuk Scepanovic 3 , Emilija Manojlovic Gacic 2,4 , Sandra Banjalic 5 , Marija Jovanovic 2,5 , Zvezdana Jemuovic 1 , Marina Nikolic Djurovic 1,2 , Danica Grujicic 2,3 , Vera Popovic 2 & Milan Petakov 1,2
1Clinic for Endocrinology, Diabetes and Diseases of Metabolism, University Clinical Center, Department of Neuroendocrinology, Belgrade, Serbia; 2Faculty of Medicine, University of Belgrade, Belgrade, Serbia; 3Clinic for Neurosurgery, University Clinical Center of Serbia, Belgrade, Serbia; 4Institute of Pathology, Belgrade, Serbia; 5Center for Radiology and Magnetic Resonance Imaging, University Clinical Center of Serbia, Belgrade, Serbia
Background: Increased life expectancy and wider availability of neuroimaging lead to increase in diagnosis of acromegaly in elderly patients, after the age of 70. Delay in diagnosis is attributable to milder symptomatology, higher prevalence of comorbidities and symptoms overlapping with normal aging process.
Objective: To investigate clinical characteristics, presenting symptoms, comorbidities and treatment modalities of acromegaly in patients diagnosed after the age of 70.
Methods: Eleven patients with acromegaly diagnosed after the age of 70 (9 females, 81.8%) were identified from the group of 121 patients with pituitary adenoma (PA) diagnosed after the age of 70 (9.1%), in the PA Database (n=1442, 0.76%) of the Department of Neuroendocrinology for the past 18 years. Gender, age at diagnosis, tumor size, presenting signs and symptoms, presence of comorbidities and treatment modality were analyzed.
Results: Mean age at diagnosis was 73.5 ± 0.8 years (range: 70-78). All patients had two or more comorbidities (median 4). Six patients (54.5%) had microadenomas, two (18.2%) had mesoadenoma, while three (27.3%) had macroadenomas. Ten patients (90.9%) had typical acromegalic clinical symptoms and signs, while one male with the largest PA (3cm in diameter) presented with neurologic symptoms (headache, instability, vertigo). Arterial hypertension was diagnosed in nine patients (81.8%), cardiomyopathy and valvular heart disease in six (54.5%), diabetes and dyslipidemia in five (45.5%). One patient had breast cancer. One patient with pituitary macroadenoma had hypopituitarism and was replaced with hydrocortisone and levothyroxine. Baseline IGF-1 was 594.7 ± 65.7 ng/ml. Five patients (45.5%) underwent transsphenoidal surgery, without complications, with significant IGF-1 decrease (573.6 ± 148.4 ng/ml preoperatively vs 159.1 ± 45.2 ng/ml postoperatively). Six patients (54.5%) were medically treated with long-acting somatostatin analogues, with favorable therapeutic response after 19.5 ± 9.6 months of therapy (IGF-1 612.3 ± 31.6 ng/ml before vs. 168.5 ± 30.3 ng/ml upon treatment).
Conclusion: Recognition of acromegaly in the elderly may be challenging and delayed due to milder symptoms overlapping with aging and comorbidities. The prevalence of the elderly among newly diagnosed acromegaly patients is expected to expand. Further studies are needed to define optimal diagnostic and therapeutic management appropriate to patients advanced average age.
Article tools
My recent searches
My recently viewed abstracts
Authors
Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
© Bioscientifica 2024 |
Privacy policy |
Cookie settings
BiosciAbstracts
Bioscientifica Abstracts is the gateway to a series of products that provide a permanent, citable record of abstracts for biomedical and life science conferences.
Find out more