Treatment outcome of acromegaly due to pituitary macroadenoma in a single tertiary centre
Introduction: Acromegaly, primarily due to a growth hormone (GH) producing pituitary macroadenoma may require several modalities of treatment to control the disease. As surgery is curable in about half of the cases, most patients require medical or radiation therapy in addition to surgery. Meth...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Malaysian Endocrine and Metabolic Society
2014
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| Subjects: | |
| Online Access: | http://irep.iium.edu.my/49073/ http://irep.iium.edu.my/49073/ http://irep.iium.edu.my/49073/6/PP-044.pdf |
| Summary: | Introduction: Acromegaly, primarily due to a growth hormone (GH)
producing pituitary macroadenoma may require several modalities of
treatment to control the disease. As surgery is curable in about half of the
cases, most patients require medical or radiation therapy in addition to
surgery.
Method: A retrospective descriptive study of acromegaly patients in
University Kebangsaan Malaysia Medical Centre from the year of 2000 to
2014.
Results: There was 14 acromegaly patients due to pituitary
macroadenoma, comprising 10 males and 4 females. The mean age at
diagnosis was 44.29 ± 10.16 years. Majority were Malays (64%), followed
by 29% Chinese and the remaining 7% were Indians. Hypertension was the
most common co-morbid (n=11), followed by diabetes (n=7), dyslipidemia
(n=5), hypopituitarism (n=4) , sleep apnea and arthralgia, 3 patients each.
Mean duration of illness was 13 ± 7 years. Mean IGF-1levels was 815.91
± 119.58 ng/ml.
Modalities of treatment included, surgery followed by medical treatment
(n=6), medical treatment alone (n=6) and one had surgery only. One patient
refused any form of treatment. The number of patients who received
somatostatin analog (SA) was 7, whereby 2 patients received SA following
surgery. Ten patients received dopaminergic agonist (DA) and 6 of them
were after surgery.
Overall response rate was 57% (n=8) of patients based on normalization
of IGF-1 levels for age and sex. The mean IGF-1 amongst the responders
was 167.25 ± 92.74 ng/ml. Five of them required combination of pituitary
surgery and medication, either DA and/or SA. Two patients responded with
medical treatment alone and one with surgical treatment alone.
Discussion: Eighty three percent achieved response from surgical followed
by medical treatment and 33% from medical therapy alone. Biochemical
control with octreotide LAR as adjunct to surgery based on IGF-1 criteria
was 67% in a study by Freda et all.1 Primary octreotide LAR and primary
cabergoline treatment resulted in normalization of IGF-1 in 34% and 20-
33% respectively, which is consistent with our findings.2-3Addition of
DA has shown to help 42% to achieve normal IGF-1 levels4. Despite the
insignificant difference in view of the small sample size in our study, more
patients went into remission with combination therapy.
Conclusion: Up to 83% of patients who had residual disease post surgery
achieved control with the use of medical therapy compared to monotherapy.
1 Freda PU, Katznelson L, van der Lely AJ, Reyes CM, Zhao S, Rabinowitz
D. Long-acting somatostatin analog therapy of acromegaly: a metaanalysis.
J Clin Endocrinol Metab. 2005;90(8): 4465–4473.
2Mercado M, Borges F, Bouterfa H, et al. A prospective, multi- centre
study to investigate the efficacy, safety and tolerability of octreotide LAR
(long-acting repeatable octreotide) in the primary therapy of patients with
acromegaly. Clin Endocrinol (Oxf). 2007;66(6):859–868.
3 Sandret L, Maison P, Chanson P. Place of cabergoline in acromegaly: a
meta-analysis. J Clin Endocrinol Metab. 2011;96(5): 1327–1335.
4Cozzi R, Attanasio R, Lodrini S, Lasio G. Cabergoline addition to depot
somatostatin analogues in resistant acromegalic patients: efficacy and lack
of predictive value of prolactin status. Clin Endocrinol (Oxf). 2004;61:209-
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