Series Of Acromegalic Patients Research Articles

THU063 Somatostatin Analog Neoadjuvant Treatment Before Endoscopic Surgery For Growth-Hormone Producing Pituitary Adenomas Invading The Cavernous Sinus: Case Series, Systematic Literature Review And Meta-analysis

Abstract Disclosure: B. Rapoport: None. A. Halstrom: None. A. Kelly: None. M. Roytman: None. J. Lantos: None. D. Phillips: None. R. Ramakrishna: None. T. Schwartz: None. G.A. Dobri: None. Background: Pituitary surgery remains the first line of treatment for acromegaly, yet 35-50% of patients with macroadenomas do not achieve biochemical remission postoperatively. Macroadenomas invading the cavernous sinus (Knosp grades 3 and 4) are particularly refractory to surgical management. Adjuvant therapy with somatostatin analogs in refractory cases is well established, but neoadjuvant use of these agents to consolidate invasive tumors prior to surgery remains controversial. Methods: We retrospectively analyzed our series of 84 consecutive cases of acromegaly treated with endoscopic transsphenoidal pituitary surgery between 2004 and 2020. We have used neoadjuvant pretreatment with somatostatin analogs for adenomas invading the cavernous sinus since 2017. We compared radiographic and long-term biochemical outcomes in the first 10 of these patients with a cohort of historical control patients who underwent resection only. We also performed a systematic review and meta-analysis of studies investigating neoadjuvant use of somatostatin analog therapy prior to transsphenoidal surgery for acromegaly. Results: Neoadjuvant therapy significantly reduced total tumor volume and volume of tumor in the cavernous sinus prior to surgery (mean reductions 30% and 48%, respectively, p<0.01), and was associated with trends toward increased rates of gross total resection and biochemical cure. Of those pretreated with neoadjuvant therapy, 60% were found to be in biochemical remission postoperatively compared to 50% in the control group, P 1. In addition, 70% of those pretreated had a gross total resection compared to 50% of controls, P 0.65. Gross total resection was achieved in all patients with Knosp grade 3 tumors, regardless of pretreatment status, and all of these patients entered biochemical remission. In patients with Knosp grade 4 tumors, gross total resection was achieved in 29% of surgery-only patients and 57% of pretreated patients; biochemical remission was achieved in 14% of surgery-only patients, and 29% of pretreated patients. The differences were not statistically significant. Conclusions: In this series of acromegalic patients with macroadenomas invading the cavernous sinus, neoadjuvant somatostatin analog therapy was associated with a trend toward increased rates of gross total resection and biochemical remission. Of note, those who were not in remission in the pretreatment group had a milder biochemical elevation and required lower-intensity medical therapy postoperatively. The systematic literature review and meta-analysis that we have performed confirm a statistically significant increase in remission rate in patients receiving neoadjuvant therapy. Presentation: Thursday, June 15, 2023

Assessment of oro-dental manifestations in a series of acromegalic patients, the AcroDent study.

Objective:The dental and periodontal impact of GH/IGF-1 hypersecretion has been poorly investigated until now. Our aim is to precisely describe the oro-dental state of acromegalic patients and to study the impact of GH/IGF-1 hypersecretion on patients’ reported oral health-related quality of life (OHRQoL).Methods:After collecting characteristics of their disease, acromegalic patients answered the GOHAI questionnaire assessing their OHRQoL, the AcroQoL questionnaire and then benefited from a complete stomatological and radiological examination (orthopantomogram systematically, retro-alveolar radiography or Cone Beam CT if necessary).Results:In total, 29 patients aged 59.1 ± 16.0 years were included. The average DMFT index (sum of Decayed, Missing and Filled Teeth per patient) was 19.0 ± 7.8. 16/29 patients had a gingivitis and 18/29 a mild to moderate chronic periodontitis, but no case of severe chronic periodontitis was found, probably because the frequency of a protective thick gingival biotype was increased (9/29). No case of generalized gingival hypertrophy or diffuse hypercementosis was observed. According to the Add-GOHAI score, only 8/26 patients had a satisfactory OHRQoL. This parameter was correlated to the acromegaly-specific quality of life according to the AcroQoL score. Interestingly, 11/29 patients had bulky oral bony outgrowths (OBO), such as large maxillary or mandibular tori and multiple vestibular exostosis.Conclusions:The unsatisfactory OHRQoL reported by acromegalic patients contrasts with a rather good objective oro-dental state and annual oral examination seems relevant in this population. Finally, we report that huge OBO could be helpful signposts for the diagnosis of acromegaly.

Assessment of oro-dental manifestations in a series of acromegalic patients, the AcroDent study

Assessment of oro-dental manifestations in a series of acromegalic patients, the AcroDent study

Prevalence of thyroid diseases in patients with acromegaly: experience of a Brazilian center

Acromegaly is frequently associated with thyroid diseases. In this study, we evaluated the frequency of thyroid disorders in a series of acromegalic patients. We evaluated 106 acromegalic patients using thyroid ultrasonography (US) and measurements of GH, IGF-I, free T4, TSH and anti-thyroperoxidase antibody levels. IGF-I was expressed in mass units and age-related standard deviation scores (SD-scores). Fine-needle aspiration biopsy (FNAB) was performed on thyroid nodules with a diameter greater than one centimeter or with suspicious characteristics. Thyroid disorders were found in 75 patients. Eleven patients had diffuse goiter, 42 patients had nodular goiter, and 22 patients had unspecific morphological abnormalities. Four patients (3.8%) had thyroid carcinoma. Considering the patients with diffuse or nodular goiter, thyroid volume was greater in patients with active acromegaly, and was positively correlated with GH, IGF-I, and IGF-I SD-score. Our study confirmed that benign thyroid diseases are frequent in acromegalic patients. The prevalence of thyroid cancer was higher than in the overall population. We suggest that thyroid US should be routinely performed in patients with acromegaly.

Factors Affecting Prognosis in a Series of Acromegalic Patients

Factors Affecting Prognosis in a Series of Acromegalic Patients

Thyroid cancer in patients with acromegaly: a case–control study

Several studies have associated acromegaly with an increased risk of benign and malignant tumors. While simple and multinodular goiters are common findings in acromegaly, the prevalence of thyroid cancer is uncertain. The objective of this study was to estimate the prevalence of thyroid cancer in a series of acromegalic patients from three hospitals in northeast of Brazil. The methodology used included morphological, cytological and histological thyroid analysis of acromegalic patients and volunteers over 18years, matched for age and sex and with nodule (s) ≥1cm. The subjects of this study were 124 acromegalic patients, including 76 females (61.3%) and 48 men (38.7%), with a mean age 45.1years. Results of the study showed that thyroid ultrasonography was normal in 31 cases (25%), 25 had diffuse goiter (20.1%), 67 had nodules (54%) and one agenesis of the right lobe (0.8%). Thirty-six patients underwent fine needle aspiration biopsy (FNAB) of their nodules and 9 cases of papillary cancer were found (7.2%). The control group consisted of 263 subjects, 156 females (59.3%) and 107 males (40.7%), mean age 44.7years. In ultrasound assessment, 96 had nodules (36.5%). Of these, 13 were punctured and 2 cases of papillary carcinoma were found (0.7%). These results gave an odds ratio of 10.21 (p=0.0011, 95% CI 2.17 to 48.01). These findings demonstrate an increased prevalence of thyroid cancer, statistically significant when compared to our control group. Thus, it is suggested that acromegalic patients should be routinely submitted to thyroid ultrasound evaluation, followed by FNAB of nodules when indicated.