Medical Treatment Landscape for Active Acromegaly in A Pituitary Center in Israel |
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| Institution: | 1. From the Department of Neurosurgery, Huashan Hospital, Shanghai Medical School, Fudan University, Shanghai, China;2. Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China;3. Medical Science in Clinical Investigation, Harvard Medical School, Boston, Massachusetts;4. Neurosurgical Institute of Fudan University, Shanghai, China;5. Shanghai Pituitary Tumor Center, Shanghai, China;6. State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai, China;7. National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China;8. Department of Endocrinology, Huashan Hospital, Shanghai Medical School, Fudan University, Shanghai, China;9. Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts. |
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| Abstract: | Objective: To evaluate current real-life experience with medical treatment for active acromegaly in a large cohort.Methods: Data on demographic parameters, blood tests, imaging studies, and treatments were extracted from the medical records.Results: The cohort included 87 patients (43 male) with active acromegaly. The mean age at diagnosis was 40.2 ± 11.4 years, and the mean duration of follow-up was 7.9 ± 5.8 years. Seventy patients presented with a macroadenoma. Mean baseline insulin growth factor 1 (IGF-1) (n = 67) was 3.2 ± 1.9 × upper limit of normal (ULN). Surgery and radiotherapy were performed in 75 and 10 patients, respectively. Currently, 38 subjects receive somatostatin analogues, pegvisomant as a monotherapy is given to 8 patients, pasireotide is given to 17 patients, cabegoline to 4 patients, estrogen to 2 females, and SSAs combined with pegvisomant to 10 patients. Eight patients are not being actively treated, including 4 following radiotherapy. Good biochemical control (IGF-1 <1.3 × ULN) was achieved in 76 patients (87%), and 11 patients (13%) are currently uncontrolled (IGF-1 >1.3 × ULN). Seventy-eight percent of controlled patients are being given 1 medication; 11% are on combination therapy; 4 patients are well controlled after radiotherapy and 2 are partially controlled without any treatment. The main adverse effects of treatment were diabetes mellitus in 7 patients (on pasireotide) and symptomatic cholelithiasis in 5 patients.Conclusion: Active acromegaly can be controlled medically in most patients, with a low rate of adverse effects. This study displays the characteristic variety of treatment options available for active acromegaly. |
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