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Erschienen in: Pituitary 1/2008

01.03.2008

An audit of treatment outcome in acromegalic patients attending our center at Bergamo, Italy

verfasst von: Roberto Attanasio, Marcella Montini, Monia Valota, Liana Cortesi, Regina Barbò, Francesco Biroli, Giampiero Tonnarelli, Mascia Albizzi, Rosa Miranda Testa, Giorgio Pagani

Erschienen in: Pituitary | Ausgabe 1/2008

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Abstract

Background Acromegaly is a chronic disease impacting on morbidity and mortality. Increased mortality is reverted after the achievement of hormonal targets. The relative role of treatment options is still matter of debate. Methods A retrospective chart review was performed on all the acromegalic patients attending our center along the last 20 years. Results Data about 159 patients (83 F) were retrieved and analyzed: 18% had been lost to follow-up, while follow-up was >5 years in 79%. Growth hormone (GH) at diagnosis was 24 μg/L (median, range 3–239). Pituitary MRI showed a macro-, micro-adenoma or no lesion in 73.6, 22.9, and 3.5%, respectively. Hyperprolactinemia (hyperPRL) was present in 20.8%. Ninety-six and 29 patients had been treated by neurosurgery (NS) and irradiated (RT), respectively. Drugs had been employed in 149 patients (in 58 as the only treatment). At the last evaluation, 22% of patients were cured (hypopituitarism and GH deficiency in 6.3%), 37.1% were controlled by ongoing pharmacological treatment, 22.6% had discordant GH and Insulin-like growth factor I (IGF-I) values, and 18.2% had still active disease (median follow-up in this last group was 9 months). By evaluating the outcome with a multimodal approach, safe GH and normal IGF-I had been achieved in 78 and 63.5% of the whole series, 80.5 and 59.7% in patients submitted to NS (and adjuvantly treated with drugs), 95.8 and 91.7% in those submitted to NS + RT (and drugs as well), 70.2 and 55.2% in those treated only with drugs (increased to 82.2 and 60.9% if considering only patients treated with modern long-acting drugs). Hypopituitarism had occurred in 25, 66.6, and 13.8% in the three groups, respectively. At multivariate analysis, previous RT and NS were significant positive predictors of cure, whereas previous NS, follow-up, and year of diagnosis were significant positive predictors of control. Diabetes was a negative predictor both of cure and control. Sex, age, baseline GH levels, hyperPRL, tumor size, extrasellar extension, and invasiveness were not independent predictors of either cure or control. Conclusion This series seems to indicate that a multimodal approach can achieve control of disease in most patients.
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Metadaten
Titel
An audit of treatment outcome in acromegalic patients attending our center at Bergamo, Italy
verfasst von
Roberto Attanasio
Marcella Montini
Monia Valota
Liana Cortesi
Regina Barbò
Francesco Biroli
Giampiero Tonnarelli
Mascia Albizzi
Rosa Miranda Testa
Giorgio Pagani
Publikationsdatum
01.03.2008
Verlag
Springer US
Erschienen in
Pituitary / Ausgabe 1/2008
Print ISSN: 1386-341X
Elektronische ISSN: 1573-7403
DOI
https://doi.org/10.1007/s11102-007-0059-1

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