Pituitary

, Volume 16, Issue 1, pp 115–121

Changes in acromegaly treatment over four decades in Spain: analysis of the Spanish Acromegaly Registry (REA)

  • Gemma Sesmilo
  • Sonia Gaztambide
  • Eva Venegas
  • Antonio Picó
  • Carlos Del Pozo
  • Concepción Blanco
  • Elena Torres
  • Cristina Álvarez-Escolà
  • Carmen Fajardo
  • Rogelio García
  • Rosa Cámara
  • Ignacio Bernabeu
  • Alfonso Soto
  • Carles Villabona
  • Alicia Serraclara
  • Irene Halperin
  • Victoria Alcázar
  • Elisabet Palomera
  • Susan M. Webb
  • on behalf of all REA investigators
Article

DOI: 10.1007/s11102-012-0384-x

Cite this article as:
Sesmilo, G., Gaztambide, S., Venegas, E. et al. Pituitary (2013) 16: 115. doi:10.1007/s11102-012-0384-x

Abstract

Since 1997 there is an online National Registry of acromegalic patients in Spain (REA). We aimed to study changes in acromegaly treatment and outcomes over the last four decades in Spain. In REA clinical and biochemical data are collected at diagnosis and updated every one to 2 years. We analyzed the first treatment received and the different treatments administered according to decade of diagnosis of acromegaly: prior to 1980, 1980–1989, 1990–1999 and 2000–2009. Surgical cure rates according to pretreatment with long-acting somatostatin receptor ligands (SRLs) were also analyzed. 1,658 patients were included of which 698 had accurate follow-up data. Treatment of acromegaly changed over time. Surgery was the main treatment option (83.8 %) and medical treatment was widely used (74.7 %) both maintained over decades, while radiation therapy declined (62.8, 61.6, 42.2 and 11.9 % over decades, p < 0.001). First treatment type also changed: surgery was the first line option up until the last decade in which medical treatment was preferred (p < 0.001). Radiotherapy was barely used as first treatment. Treatment combinations changed over time (p < 0.001). The most common treatment combination (surgery plus medical therapy), was received by 24.4, 16.4, 25.3 and 56.5 % of patients over decades. Medical treatment alone was performed in 7.3, 6, 7.2 and 14.7 % over decades. Type of medical treatment also changed, SRLs becoming the first medical treatment modality in the last decades, whereas dopamine agonist use declined (p < 0.001). Surgical cure rates improved over decades (21, 21, 36 and 38 %, p = 0.002) and were not influenced by SRL pre-surgical use. Acromegaly treatment has changed in Spain in the last four decades. Surgery has been the main treatment option for decades; however, medical therapy has replaced surgery as first line in the last decade and radiotherapy rates have clearly declined. SRLs are the most used medical treatment.

Keywords

AcromegalyRegistryTreatment

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Gemma Sesmilo
    • 1
  • Sonia Gaztambide
    • 2
  • Eva Venegas
    • 3
  • Antonio Picó
    • 4
  • Carlos Del Pozo
    • 5
  • Concepción Blanco
    • 6
  • Elena Torres
    • 7
  • Cristina Álvarez-Escolà
    • 8
  • Carmen Fajardo
    • 9
  • Rogelio García
    • 10
  • Rosa Cámara
    • 11
  • Ignacio Bernabeu
    • 12
  • Alfonso Soto
    • 3
  • Carles Villabona
    • 13
  • Alicia Serraclara
    • 14
  • Irene Halperin
    • 15
  • Victoria Alcázar
    • 16
  • Elisabet Palomera
    • 17
  • Susan M. Webb
    • 18
  • on behalf of all REA investigators
  1. 1.Servicio de EndocrinologíaInstitut Universitari DexeusBarcelonaSpain
  2. 2.Servicio de EndocrinologíaHospital de CrucesBarakaldoSpain
  3. 3.Servicio de EndocrinologíaHospital Universitario Virgen del RocíoSevillaSpain
  4. 4.Servicio de EndocrinologíaHospital General UniversitarioAlicanteSpain
  5. 5.Servicio de EndocrinologíaHospital Mútua de TerrassaTerrassaSpain
  6. 6.Servicio de EndocrinologíaHospital Príncipe de AsturiasMadridSpain
  7. 7.Servicio de EndocrinologíaHospital Universitario San CecilioGranadaSpain
  8. 8.Servicio de EndocrinologíaHospital Universitario la PazMadridSpain
  9. 9.Servicio de EndocrinologíaHospital de la RiberaAlziraSpain
  10. 10.Servicio de EndocrinologíaHospital Gregorio MarañónMadridSpain
  11. 11.Servicio de EndocrinologíaHospital La FeValenciaSpain
  12. 12.Servicio de EndocrinologíaHospital Clínico Universitario de SantiagoSantiago de CompostelaSpain
  13. 13.Servicio de EndocrinologíaHospital de BellvitgeBarcelonaSpain
  14. 14.Servicio de EndocrinologíaHospital 12 de OctubreMadridSpain
  15. 15.Servicio de EndocrinologíaHospital ClínicBarcelonaSpain
  16. 16.Servicio de EndocrinologíaHospital Severo OchoaMadridSpain
  17. 17.Estadística, Unitat de RecercaHospital de MataróMataróSpain
  18. 18.IIB- Sant Pau y Servicio de Endocrinología, Departamento de Medicina y Centro de Investigación Biomédica en Enfermedades Raras (CIBER-ER Unidad 747), Hospital Sant PauUniversitat Autònoma de BarcelonaBarcelonaSpain