AACE2021-A-1093: Diagnostic Characteristics and Management Outcome in Patients with Acromegaly: A 15-Year Experience at a Tertiary Care Hospital in Pakistan

Abstract

Acromegaly is due to excess Growth hormone (GH) production, usually a result of pituitary adenoma. The diagnosis is often preceded by around 5 years of the active but unrecognized disease. Clinical expression of the disease in each patient depends on the levels of GH and Insulin-like Growth Factor-1 (IGF-1), age, tumor size, and the delay in diagnosis. Successful remission after Trans-sphenoidal surgery (TSS) is reported to be found in 52.5% of cases in the developed countries. It was a Descriptive cohort study. Total 84 patients with biochemical and radiological diagnoses of Acromegaly were included in the study between January, 2005 to December, 2019. Patients’ medical record files were reviewed & data recorded Of the 84 subjects, with a mean age of 38.69 ± 13.52 years, 54 (64.3%) were male while 30 (35.7%) were female. The patients presented at a mean duration of 5.43 ± 4.3 years after the onset of symptoms. The most frequent complaint was somatic growth features in the form of enlarged hands & feet noted by 81 (96.4%) pts. Overall, 73 (86.9%) patients underwent TSS for removal of pituitary adenoma while 11 (13.1%) patients refused to opt for the surgical option. Only 9 (12.3%) patients achieved biochemical & radiological remission after 6 months of surgery. Among 64 patients with persistent disease after TSS, 38 (59.4%) were treated with radiosurgery/radiotherapy, 15 (23.4%) underwent repeat TSS and 11 (17.2%) opted for medical treatment, mostly with Cabergoline. TSS is followed by the documentation of a high rate (88%) of failure to achieve remission and the majority of patients have to opt for radiotherapy/repeat TSS for the persistent disease. With the continuously improving surgical skills, we expect that the figures attaining remission after primary TSS will rise in the decades to come.