Endocrine Abstracts

Introduction: Acromegaly is a disorder caused by excessive secretion of growth hormone, often due to pituitary masses. The first step in treatment is transsphenoidal surgery. Cabergoline, somatostatin receptor ligands or pegvisomant may be used in patients with an inadequate response after surgery. Finally, radiotherapy may be used in patients with inadequate response to medical treatment.

Methods: In this retrospective study, data of 89 patients (59 females, 30 males) diagnosed with acromegaly in Ankara University Hospitals between 2002 and 2024 were analysed.

Results: The mean age at diagnosis was 40.2±11.4 years and the mean follow-up was 97.6±77.9 months. Pituitary surgery was performed in 82 of 89 patients and the postoperative remission rate was 31.7% (n=26/82). Patients (n=62) who did not achieve remission or who relapsed during follow-up underwent reoperation (n=22/62, 35.4%) and/or radiotherapy (n=17/62, 27.4%) and/or medical therapy (n=54/62, 62%). Of the 60 patients treated with medical therapy, 36 (60%) received monotherapy and 24 (40%) received combination therapy. Remission was achieved in 38 (63.3%) patients. Of the 60 patients, 33 (55%) were treated with somatostatin receptor ligand (SRL) monotherapy, 3 (5%) with dopamine agonist (DA) monotherapy, 16 (26.6%) with SRL and DA combination, 5 (8.3%) with SRL, DA and pegvisomant combination, 3 (5%) with SRL and pegvisomant combination. When analysing the patients who were receiving medical treatment, it was observed that there was a delay in treatment change in 6 patients. The mean delay in switching treatment was 61.5 months. The economic status of the patients, the Covid pandemic, referrals to different and inappropriate centres and patient non-compliance were found to be the reasons for this delay.

Conclusion: Despite many advances in medical and surgical treatment, some patients with acromegaly are not adequately treated. In cases SRLs are insufficient, switching to pegvisomant or a combination therapy of pegvisomant and SRLs is recommended.¹ Switching to new treatment regimens based on patient characteristics in all patients who do not achieve remission will increase the success of acromegaly treatment. The success of acromegaly treatment can also be increased by evaluating patients in experienced centers.

Reference : 1. Melmed S, Bronstein MD, Chanson P, Klibanski A, Casanueva FF, Wass JAH, et al. A Consensus Statement on acromegaly therapeutic outcomes. Nat Rev Endocrinol. 2018;14(9):552-61.