title: An audit of treatment outcome in acromegalic patients attending our center at Bergamo, Italy.
abstract: BACKGROUND
  Acromegaly is a chronic disease impacting on morbidity and mortality. Increased mortality is reverted after the achievement of hormonal targets. The relative role of treatment options is still matter of debate.
  
  
  METHODS
  A retrospective chart review was performed on all the acromegalic patients attending our center along the last 20 years.
  
  
  RESULTS
  Data about 159 patients (83 F) were retrieved and analyzed: 18% had been lost to follow-up, while follow-up was >5 years in 79%. Growth hormone (GH) at diagnosis was 24 microg/L (median, range 3-239). Pituitary MRI showed a macro-, micro-adenoma or no lesion in 73.6, 22.9, and 3.5%, respectively. Hyperprolactinemia (hyperPRL) was present in 20.8%. Ninety-six and 29 patients had been treated by neurosurgery (NS) and irradiated (RT), respectively. Drugs had been employed in 149 patients (in 58 as the only treatment). At the last evaluation, 22% of patients were cured (hypopituitarism and GH deficiency in 6.3%), 37.1% were controlled by ongoing pharmacological treatment, 22.6% had discordant GH and Insulin-like growth factor I (IGF-I) values, and 18.2% had still active disease (median follow-up in this last group was 9 months). By evaluating the outcome with a multimodal approach, safe GH and normal IGF-I had been achieved in 78 and 63.5% of the whole series, 80.5 and 59.7% in patients submitted to NS (and adjuvantly treated with drugs), 95.8 and 91.7% in those submitted to NS + RT (and drugs as well), 70.2 and 55.2% in those treated only with drugs (increased to 82.2 and 60.9% if considering only patients treated with modern long-acting drugs). Hypopituitarism had occurred in 25, 66.6, and 13.8% in the three groups, respectively. At multivariate analysis, previous RT and NS were significant positive predictors of cure, whereas previous NS, follow-up, and year of diagnosis were significant positive predictors of control. Diabetes was a negative predictor both of cure and control. Sex, age, baseline GH levels, hyperPRL, tumor size, extrasellar extension, and invasiveness were not independent predictors of either cure or control.
  
  
  CONCLUSIONS
  This series seems to indicate that a multimodal approach can achieve control of disease in most patients.
authors: Endocrinology, Istituto Ortopedico Galeazzi, Dr. Roberto Attanasio, via Compagnoni 1, Milano 20129, Italy. roberto.serena@libero.it
authors: Roberto
authors: R
authors: Attanasio
authors: Marcella
authors: M
authors: Montini
authors: Monia
authors: M
authors: Valota
authors: Liana
authors: L
authors: Cortesi
authors: Regina
authors: R
authors: Barbò
authors: Francesco
authors: F
authors: Biroli
authors: Giampiero
authors: G
authors: Tonnarelli
authors: Mascia
authors: M
authors: Albizzi
authors: Rosa Miranda
authors: RM
authors: Testa
authors: Giorgio
authors: G
authors: Pagani
mesh_terms: D000172:Acromegaly / Q000209:etiology / Q000378:metabolism / Q000473:pathology / Q000628:therapy*; D000236:Adenoma / Q000150:complications* / Q000378:metabolism / Q000473:pathology / Q000628:therapy; D000293:Adolescent; D000328:Adult; D000368:Aged; D054869:Clinical Audit; D018491:Dopamine Agonists / Q000627:therapeutic use; D005260:Female; D019382:Human Growth Hormone / Q000172:deficiency; D006801:Humans; D006966:Hyperprolactinemia / Q000209:etiology / Q000628:therapy; D007016:Hypophysectomy; D007018:Hypopituitarism / Q000209:etiology / Q000628:therapy; D007558:Italy; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010911:Pituitary Neoplasms / Q000150:complications* / Q000378:metabolism / Q000473:pathology / Q000628:therapy; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D013004:Somatostatin / Q000031:analogs & derivatives / Q000627:therapeutic use; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D018491:Dopamine Agonists; D019382:Human Growth Hormone; D013004:Somatostatin
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