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Changes in multi-modality management of acromegaly in a tertiary centre over 2 decades

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Abstract

Purpose

Acromegaly is a rare disease associated with chronic multisystem complications. New therapeutic strategies have emerged in the last decades, combining pituitary transsphenoidal surgery (TSS), radiotherapy or radiosurgery (RXT) and medical treatments.

Methods

This retrospective monocentric study focused on presentation, management and outcome of acromegaly patients diagnosed between 2000 and 2020, still followed up in 2020, with a minimum follow-up of 1 year, and comparison of the first vs. second decade of the study.

Results

275 patients were included, 50 diagnosed before 2010 and 225 after 2010. 95% of them had normal IGF-1 levels (with or without treatment) at the last follow-up. Transsphenoidal surgery was more successful after 2010 (75% vs. 54%; p < 0.01), while tumor characteristics remained the same over time. The time from first treatment to biochemical control was shorter after 2010 than before (8 vs. 16 months; p = 0.03). Since 2010, RT was used less frequently (10% vs. 32%; p < 0.01) but more rapidly after surgery (26 vs. 53 months; p = 0.03). In patients requiring anti-secretory drugs after TSS, the time from first therapy to biochemical control was shorter after 2010 (16 vs. 29 months; p < 0.01). Tumor size, tumor invasiveness, baseline IGF-1 levels and Trouillas classification were identified as predictors of remission.

Conclusion

The vast majority of patients with acromegaly now have successful disease control with a multimodal approach. They reached biochemical control sooner in the most recent half of the study period. Future work should focus on those patients who are still uncontrolled and on the sequelae of the disease.

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Data availability

No datasets were generated or analysed during the current study.

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Funding

This work was supported by the “Association pour le Développement de la Recherche Médicale au Centre Hospitalier Universitaire de Marseille” (ADEREM) and by an unrestricted educational grant from IPSEN Pharma.

Author information

Authors and Affiliations

  1. Marseille Medical Genetics, Institut MarMaRa, INSERM, UMR1251, Aix Marseille Univ, Marseille, France

    V. Amodru, N. Sahakian, C. Piazzola, T. Cuny, I. Morange, F. Albarel, M. Vermalle, T. Brue & F. Castinetti

  2. Department of Endocrinology, Hôpital La Conception, Service d’Endocrinologie, Institut MarMaRa, APHM, Aix Marseille Univ, 147 Boulevard Baille, 13005, Marseille, France

    V. Amodru, N. Sahakian, C. Piazzola, T. Graillon, T. Cuny, I. Morange, F. Albarel, M. Vermalle, H. Dufour, T. Brue & F. Castinetti

  3. Department of Pathology, Hôpital La Timone, APHM, Aix Marseille Univ, Marseille, France

    R. Appay

  4. Department of Neurosurgery, Hôpital La Timone, APHM, Aix Marseille Univ, Marseille, France

    T. Graillon & H. Dufour

  5. Department of Functional Neurosurgery, Hôpital La Timone, APHM, Aix Marseille Univ, Marseille, France

    J. Regis

Authors
  1. V. Amodru
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  2. N. Sahakian
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  3. C. Piazzola
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  7. I. Morange
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  10. J. Regis
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Contributions

V.A and FC wrote the manuscript and prepared figures. V.A, N.S and C.P collected the data. All authors reviewed the manuscript.

Corresponding author

Correspondence to F. Castinetti.

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Competing interests

Thierry Brue has received conference/consultancy fees and/or research grants from Association Française contre les Myopathies (AFM Telethon), Ipsen, Lilly, Novartis, Novo-Nordisk, Pfizer and Recordati, and served as clinical trial investigator for Crinetics, Debiopharm, Recordati and Xeris. Frederic Castinetti has received conference/consultancy fees and/or research grants from Ipsen, Recordati rare diseases, and served as clinical trial investigator for Recordati rare diseases.

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Amodru, V., Sahakian, N., Piazzola, C. et al. Changes in multi-modality management of acromegaly in a tertiary centre over 2 decades. Pituitary (2024). https://doi.org/10.1007/s11102-024-01387-y

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