Endocrine Abstracts

Aim: Acromegaly is associated with multiple co-morbidities including diabetes mellitus (DM), obstructive sleep apnoea (OSA), arthropathy, cardiovascular events and malignancies. Early diagnosis and treatment, with an intention to cure or control the growth hormone (GH) exposure can reduce risk of these complications. The aim of this study is to assess the development of acromegaly-related complications amongst patients who have completed at least 10 years of follow up after achieving disease control.

Methods: 167 patients who were treated for acromegaly in our tertiary pituitary referral centre (1940 -2012) were included in this retrospective observational study. 81/167 had achieved disease control. 31/81 had been discharged back to the care of the peripheral district general hospitals from which they were referred and hence were not included in the analysis (due to inaccessibility of case files). The case notes, general practice summary care records of 50/81 were subsequently included in the analysis and reviewed for development of any new complications after 10 years of cure and follow up thereafter.

Results: n=50: 30 patients remain under follow up and 20 patients had died. The mean duration of follow up was 291 months among patients on follow up and 259 months for those who had died. 21/50 patients did not develop any new complications throughout their follow up. 21/50 developed at least one complication of which 18 developed their complication after 10 years follow-up after cure: HT (n=9), DM (n=7), malignancy (n=9; one patient developed two malignancies), OSA (n=2), CCF (n=3), TMJ joint pathology (n=1) and dementia (n=1). [A further 9 patients had developed HT and 5 developed DM within 10 years after control]. On comparing the patients who remained normal (n=21) with those who developed complications after 10 years (n=18), there was no statistical difference in age at diagnosis (40.7 ± 14.6 vs. 45.4 ± 10.2 years), GH at diagnosis (23.4 ± 36.2 vs. 14.2 ± 16.5 mg/l), time to achieve control (55 ± 55 vs. 38 ± 46 months), modalities to achieve cure, total treatments required to achieve cure or the proportion of macroadenomas (17/21 vs. 13/18)

Conclusions: Our observational analysis of clinical practice demonstrates significant acromegaly–related complications developing during long term follow up of acromegaly despite achieving biochemical control. Though this study did not involve multivariate analysis and adjustment for other relevant risk factors for the comorbidities, it reemphasizes the need for continued monitoring and need for analysis of larger databases