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

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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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Abbreviations

ACTH:

Adrenocorticotropin

DA:

Dopamine agonist drugs

FN:

False negatives

FP:

False positives

GH:

Growth hormone

GHRH:

GH-releasing hormone

GK:

Gamma-knife radio-surgery

IGF-I:

Insulin-like growth factor I

LAR:

Long-acting repeatable

LR:

Likelihood ratio

MRI:

Magnetic resonance imaging

NS:

Neurosurgery

OGTT:

Oral glucose tolerance test

Postodd:

Estimated post-test odd

Preodd:

Estimated pre-test odd

PRL:

Prolactin

RT:

Radiotherapy

SA:

Somatostatin analogs

TN:

True negatives

TP:

True positives

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Acknowledgments

We are indebted to all the physicians and nurses who took care of the patients throughout the years, as well as to all the patients who trusted us and allowed us to get insight into the different aspects of this fascinating disease.

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Authors and Affiliations

  1. Endocrinology, Istituto Ortopedico Galeazzi, Dr. Roberto Attanasio, via Compagnoni 1, Milano , 20129, Italy

    Roberto Attanasio

  2. Department of Endocrinology, Ospedali Riuniti Bergamo, Bergamo, Italy

    Roberto Attanasio, Marcella Montini, Monia Valota, Liana Cortesi, Mascia Albizzi, Rosa Miranda Testa & Giorgio Pagani

  3. Department of Neuroradiology, Ospedali Riuniti Bergamo, Bergamo, Italy

    Regina Barbò

  4. Department of Neurosurgery, Ospedali Riuniti Bergamo, Bergamo, Italy

    Francesco Biroli

  5. Department of Neurosurgery, Ospedale Legnano, Legnano, Italy

    Giampiero Tonnarelli

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  1. Roberto Attanasio
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  2. Marcella Montini
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  3. Monia Valota
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Correspondence to Roberto Attanasio.

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Attanasio, R., Montini, M., Valota, M. et al. An audit of treatment outcome in acromegalic patients attending our center at Bergamo, Italy. Pituitary 11, 1–11 (2008). https://doi.org/10.1007/s11102-007-0059-1

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