Endocrine Abstracts

Introduction: The management of acromegaly is commonly based on selective transsphenoidal adenomectomy (STA) as a first-line treatment, and other therapeutic options including somatostatin analogues (SA), dopamine agonists (DA) and radiotherapy as second-line treatment or in case of operative contraindications. The aim of our study was to assess the remission rate and to determine the predictive factors for long-term remission in acromegalic patients.

Methods: We conducted a retrospective study including 27 acromegalic patients followed in the endocrinology department of Charles Nicolle hospital during the period from 1989 to 2022. Clinical, biochemical, imaging and therapeutic data were extracted from medical records. According to hormonal outcome, patients were subdivided into two groups: remission vs improvement/stabilization.

Results: There were 16 (59%) women and 11 (41%) men with a mean age at the diagnosis of acromegaly of 46.6 ± 13.7 years. The median (IQR) initial GH level was 21.6 ng/ml (7.8-47.0). STA, SA, DA and radiotherapy were used in 67, 22, 4 and 26% of cases, respectively. Long-term remission was obtained in 10 patients (37%), while most patients (63%) had a persistent disease (improvement or stabilization). Patients who underwent STA had a significantly higher remission rate compared with unoperated patients (P=0.009). We did not found significant correlations between adenoma size, initial GH and post-therapeutic GH levels. We did not observe significant associations between remission rate and the following parameters: age, sex, locoregional invasion, pituitary deficiencies, vision loss, use of SA, DA and radiotherapy.

Conclusion: The prognosis of acromegaly depends mainly on early and effective tanssphenoidal resection of somatotroph adenoma. Medical treatment and radiotherapy can not lead to remission unless combined with STA.