Aftercare in patients with Cushing's disease and acromegaly: is there room for improvement?
OBJECTIVE
Evaluation of aftercare, medical therapy and remission rate for Cushing's disease (CD) and acromegaly (AC).


METHODS
Fifty-eight CD and 83 AC patients operated on over 10 years were carefully evaluated. The patients received a disease-related questionnaire and were invited for a follow-up at the outpatient clinic of the Department of Neurosurgery. Thirty-three CD and 52 AC patients returned the questionnaire; 25 CD and 37 AC patients participated personally. CD patients underwent a dexamethasone suppression test, and IGF-1 levels were assessed in AC patients. Data on postoperative therapy were assessed.


RESULTS
84.8% of those with CD and 75.0% of those with AC had been followed by endocrinologists; 9.1% of CD and 1.9% of AC patients had been under no aftercare; 96% of CD patients were in remission. A recurrence occurred in four patients, two were newly detected by our study. IGF-1 was postoperatively normalized in 25 of 37 AC patients (67.6%). Twenty patients remained in remission, five relapsed. One patient received medical therapy upon recurrence and presented normal IGF-1; four patients with relapse had not been treated yet. Ten of 12 patients with elevated early postoperative IGF-1 received medical therapy that was commenced within 6 months in nine cases. The mean duration of medical therapy was 36 months (range 2-92). IGF-1 was still elevated at the last follow-up in eight of these ten patients, all of them receiving monotherapy. In four patients, the dose had been increased once.


CONCLUSIONS
The postoperative transfer back to the endocrinologist after operative treatment is achieved well in both groups. In uncured AC, medical therapy is initiated early, but options of therapy offer room for improvement. Therapy of recurrence is delayed in both pathologies.
Psaras
Tsambika
T
Department of Neurosurgery, University of Tuebingen, Hoppe-Seyler-Strasse 3, 72076 Tuebingen, Germany. tsambika.psaras@med.uni-tuebingen.de
Milian
Monika
M
Hattermann
Valerie
V
Gallwitz
Baptist
B
Freiman
Thomas
T
Honegger
Juergen
J
D000172:Acromegaly / Q000175:diagnosis / Q000188:drug therapy* / Q000601:surgery; D000236:Adenoma / Q000150:complications / Q000601:surgery; D000328:Adult; D000359:Aftercare / Q000379:methods* / Q000706:statistics & numerical data*; D000368:Aged; D015415:Biomarkers / Q000032:analysis / Q000378:metabolism; D003430:Cross-Sectional Studies; D004704:Endocrinology / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D019382:Human Growth Hormone / Q000031:analogs & derivatives / Q000627:therapeutic use; D006801:Humans; D007334:Insulin-Like Growth Factor I / Q000032:analysis / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D009493:Neurosurgery / Q000706:statistics & numerical data; D019635:Neurosurgical Procedures; D015282:Octreotide / Q000627:therapeutic use; D017063:Outcome Assessment, Health Care; D010456:Peptides, Cyclic / Q000627:therapeutic use; D047748:Pituitary ACTH Hypersecretion / Q000175:diagnosis / Q000188:drug therapy* / Q000601:surgery; D010911:Pituitary Neoplasms / Q000150:complications / Q000601:surgery; D011785:Quality Assurance, Health Care / Q000379:methods*; D012008:Recurrence; D013004:Somatostatin / Q000031:analogs & derivatives / Q000627:therapeutic use; D011795:Surveys and Questionnaires
D015415:Biomarkers; D010456:Peptides, Cyclic; C060347:lanreotide; D019382:Human Growth Hormone; D013004:Somatostatin; D007334:Insulin-Like Growth Factor I; C406545:pegvisomant; D015282:Octreotide