Endocrine Abstracts

Background: Acromegaly is a rare endocrine disorder characterized by excess growth hormone (GH) secretion. GH hypersecretion leads to the overproduction of insulin-like growth factor 1 (IGF-1), which has both somatic and metabolic effects. Hypogonadotropic hypogonadism is present in nearly 30%–50% of acromegaly patients. There is a close correlation between somatotropic axis and gonadal function. The aim of this study was to investigate the prevalence of hypogonadism in male patients with acromegaly and the effect of surgical treatment during follow-up.

Material and methods: The study has a retrospective design. Medical records of patients diagnosed with acromegaly, hospitalized pre- and postoperative between January 2015 and December 2022 have been analyzed. Clinical history, laboratory results and endocrine tests were routinely recorded. All patients underwent a pituitary MRI to determine tumor size and invasion type. The significance level was set at α = 0.05 for all analyses. The statistical analysis was performed with Statistica 13.3 (StatSoft, Cracow, Poland).

Results: The analysis involved a total of 62 pre-operative and 60 post-operative male patients. Hypogonadism was diagnosed in 48 males pre-operative (77.42%). Following surgery, the prevalence of hypogonadism decreased to 60%, (n=36). Fisher’s Exact Test yielded P=0.00174. Most of the patients presented with macroadenoma (53.22%). Postoperative testosterone concentrations increased significantly (8.7 vs 12.0 nmol/l; P<0.001), particularly in patients with preoperative hypogonadism (7.2 vs 10.2 nmol/l; P<0.001). Gonadotropin levels postoperatively demonstrated a significant elevation (LH: 3.4 vs 3.75 mlU/ml; P=0.007; FSH: 5.35 vs 5.90 mlU/ml; P=0.032), especially in patients with preoperative hypogonadism (LH: 2.85 vs 3.20 mlU/ml; P=0.003; FSH: 5.10 vs 6.05 mlU/ml; P=0.032). Testosterone levels were found to be statistically significantly lower in patients with macroadenoma compared to microadenoma (7.2 nmol/l vs 11.05 nmol/l; P=0.038). Hypogonadism manifested more frequently in younger patients (<50 years). Prolactin levels were elevated in patients with preoperative hypogonadism and macroadenoma (304 μIU/ml; P=0.036). GH and IGF-1 concentrations postoperatively decreased (GH: 3.0 vs 1.4 ng/ml; P=0.002; IGF-1: 506 vs 278 ng/ml; P<0.001). Patients with preoperative hypogonadism presented higher median baseline values of GH and IGF-1 (GH: 3.74 ng/ml; IGF-1: 556) compared to those without hypogonadism (GH: 1.42 ng/ml; IGF-1: 379.5 ng/ml). Total cholesterol and low-density lipoprotein (Ldl) values experienced a statistically significant reduction postoperatively across all cohorts (P<0.001).

Conclusions: : Younger patients diagnosed with macroadenoma, and hyperprolactinemia exhibit a higher predisposition to pre-operative hypogonadism. Neurosurgical treatment can lead to the normalization of GH and IGF-1, but also LH, FSH, and total testosterone.