Surgical and Pharmacological Outcomes in Acromegaly: Real-Life Data From the Mexican Acromegaly Registry

J Clin Endocrinol Metab. 2020 Dec 1;105(12):dgaa664. doi: 10.1210/clinem/dgaa664.

Abstract

Context: Acromegaly registries constitute a valuable source of therapeutic outcome information in real-life.

Objective: The objective of this work is to analyze surgical and pharmacological outcomes in the Mexican Acromegaly Registry (MAR).

Design and methods: Data were extracted from the MAR informatic platform. Surgical remission was defined by a postoperative postglucose (GH) of less than 1 ng/mL and an insulin-like growth factor 1 (IGF-1) of less than 1.2 × upper limit of normal (ULN). Pharmacological remission was defined by a basal GH of less than 1 ng/mL and an IGF-1 of less than 1.2 × ULN.

Results: A total of 650 surgical outcomes were analyzed (94.6% transsphenoidal). Surgical remission was achieved in 40.15%, whereas 44.15% remained biochemically active. Persistently active disease after surgery was significantly associated with harboring an invasive macroadenoma, a basal GH of greater than 10 ng/mL, and/or an IGF-1 of greater than 2 × ULN at diagnosis on bivariate and multivariate analysis. The outcome of monotherapy with first-generation somatostatin analogs (SSAs) was evaluated in 267 patients (adjunctive in 65%), of whom 28.4% achieved remission. Persistently active disease was significantly associated with harboring an invasive macroadenoma as well as with pretreatment basal GH and IGF-1 levels of greater than 10 ng/mL and greater than 2 × ULN, respectively, on bivariate and multivariate analysis. Combined therapy with SSA and cabergoline was analyzed in 100 patients, of whom 19% achieved remission and 44% remained active; in this subset of patients, only a pretreatment IGF-1 of greater than 2 × ULN was significantly associated with persistent disease activity.

Conclusion: Surgical and pharmacological outcomes in acromegaly are highly dependent on tumor size/invasiveness as well as on the degree of hypersomatotropinemia.

Keywords: GH; IGF-1; acromegaly registries; cabergoline; lanreotide; octreotide; transsphenoidal surgery.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acromegaly / diagnosis
  • Acromegaly / drug therapy*
  • Acromegaly / epidemiology
  • Acromegaly / surgery*
  • Adenoma / diagnosis
  • Adenoma / drug therapy
  • Adenoma / epidemiology
  • Adenoma / surgery
  • Adult
  • Cabergoline / therapeutic use
  • Combined Modality Therapy
  • Female
  • Growth Hormone-Secreting Pituitary Adenoma / diagnosis
  • Growth Hormone-Secreting Pituitary Adenoma / drug therapy
  • Growth Hormone-Secreting Pituitary Adenoma / epidemiology
  • Growth Hormone-Secreting Pituitary Adenoma / surgery
  • Human Growth Hormone / blood
  • Humans
  • Insulin-Like Growth Factor I / metabolism
  • Male
  • Mexico / epidemiology
  • Middle Aged
  • Neurosurgical Procedures
  • Postoperative Period
  • Prognosis
  • Registries
  • Retrospective Studies
  • Somatostatin / analogs & derivatives
  • Treatment Outcome

Substances

  • Human Growth Hormone
  • Somatostatin
  • Insulin-Like Growth Factor I
  • Cabergoline