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Medical treatment of acromegaly—experience from the Croatian acromegaly registry

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Abstract

Purpose

The aim of this study was to review therapeutic outcomes of the medical treatment of patients with acromegaly based on real-world data from the Croatian Acromegaly Registry.

Methods

In this retrospective study we investigated 163 patients (101 female, 62 male, age at diagnosis 47.2 ± 13.4 years) treated between 1990 and 2020, of which 53 were treated medically (32.5%). The duration of follow-up was 115.8 ± 304.4 months. The remission rate after the pituitary surgery was achieved in 66.5% (n = 105/158; 5 patients refused surgery). Patients who did not achieve disease remission or had a relapse during follow-up (n = 2), underwent reoperation (n = 18/60, 30%) and/or radiotherapy (n = 33/60, 55%) and/or medical treatment (n = 53/60, 88.3%). One patient refused further treatment after the failure of the first pituitary surgery.

Results

Out of 53 patients treated with medical therapy, monotherapy was used in 34 (64.2%) and combination therapy in 19 (35.8%) patients. Remission (IGF-I < 1.2 upper limit of normal, ULN) was achieved in 51 patients (96.2%). Out of 53 patients, 21 (39.6%) were treated with first-generation somatostatin receptor ligand (SRL-1) monotherapy, 10 (18.9%) with dopamine agonist (DA) monotherapy, one (1.9%) with pegvisomant monotherapy, 13 (24.4%) with a combination of SRL-1 and DA, three (5.7%) with a combination of SRL-1, DA and pegvisomant, two (3.8%) with a combination of second-generation somatostatin receptor ligand (SRL-2), DA and pegvisomant and in one (1.9%) temozolomide was added on top of SRL-1 and DA. Two patients currently have active disease, both on SRL-1 monotherapy, of whom one is non-adherent to the treatment. Radiotherapy was applied to 27 (50.9%) patients on medical therapy.

Conclusion

Our results indicate that almost all patients with active acromegaly after pituitary surgery can achieve biochemical control with medical treatment.

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Acknowledgements

The authors would like to thank the members of Croatian Acromegaly Registry (CRO-ACRO) Study Group: Vjerislav Peterkovic and Zdravko Heinrich, Clinic of Neurosurgery, University Hospital Centre Zagreb, Marcel Marjanovic-Kavanagh and Katarina Vukovic Duric, Clinic of Otorhinolaryngology, University Hospital Centre Zagreb, David Ozretic, Clinic of Neuroradiology, University Hospital Centre Zagreb.

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Authors and Affiliations

  1. Department of Endocrinology, University Hospital Centre Zagreb, Kišpatićeva 12, 10000, Zagreb, Croatia

    Mirsala Solak, Ivana Kraljević, Hrvoje Popovac, Tanja Škorić Polovina, Annemarie Balaško, Karin Zibar Tomšić, Tina Dušek & Darko Kaštelan

  2. School of Medicine, University of Zagreb, Šalata 3, 10000, Zagreb, Croatia

    Ivana Kraljević, Tina Dušek & Darko Kaštelan

  3. Department of Internal medicine, General Hospital Koprivnica, Željka Selingera bb, 48000, Koprivnica, Croatia

    Lana Šambula

  4. Department of Endocrinology, University Hospital Centre Split, Spinčićeva 1, 21000, Split, Croatia

    Anela Novak

  5. Department of Endocrinology, University Hospital Centre Osijek, Josipa Huttlera 4, 31000, Osijek, Croatia

    Marija Tripolski

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  1. Mirsala Solak
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  2. Ivana Kraljević
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Correspondence to Mirsala Solak.

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Solak, M., Kraljević, I., Popovac, H. et al. Medical treatment of acromegaly—experience from the Croatian acromegaly registry. Endocrine 81, 555–561 (2023). https://doi.org/10.1007/s12020-023-03430-7

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