title: Acromegaly: presentation, morbidity and treatment outcomes at a single centre.
abstract: OBJECTIVE
  Analysis of patients with acromegaly followed-up at a single centre, focusing on baseline characteristics, morbidity and efficacy of treatment.
  
  
  METHODS
  Retrospective review of electronic medical records of acromegalics from 1987 to 2009.
  
  
  RESULTS
  One hundred and fifteen patients (45 men), aged 47 ± 14 years, with a mean follow-up of 8.8 ± 0.8 years were studied. Twenty-five per cent had micro- and 75% macroadenomas. Forty-three per cent presented with visual field defects, 49% had hypertension, 25% diabetes mellitus and 35% dyslipidaemia. At follow-up, 50% had myocardial hypertrophy, 55% colon polypodiasis, 74% nodular thyroid disease and 18% adrenal masses. Surgery was performed in 79% (8% twice), followed by conventional radiotherapy in 27%. Fifty-two per cent of the patients achieved remission. Disease control was reported in 65% of microadenomas and 41% of macroadenomas. Remission rates with surgery alone were 41%. Improvement of remission rates was achieved with subsequent treatment with somatostatin analogues (SSA) (53%), or conventional radiotherapy (63%). Nevertheless, pituitary reserve was compromised with the latter. SSA significantly improved outcomes in microadenomas, even as a monotherapy (remission in 89%), in contrast to macroadenomas (0%), although these agents were associated with impaired glucose metabolism and cholelithiasis in half of the patients.
  
  
  CONCLUSIONS
  Acromegaly is associated with an increased morbidity. About half of the treated patients achieved remission (2/3 of microadenomas). The best outcomes were reported for the combination of surgery with radiotherapy, in spite of a higher risk of hypopituitarism. SSA led to remission in a significant percentage of microadenomas, but was associated with increased rates of cholelithiasis and impaired glucose homeostasis.
authors.affiliation: Department of Endocrinology, Hippokration General Hospital of Thessaloniki, Thessaloniki, Greece.
authors.forename: P
authors.initials: P
authors.lastname: Anagnostis
authors.forename: Z A
authors.initials: ZA
authors.lastname: Efstathiadou
authors.forename: S A
authors.initials: SA
authors.lastname: Polyzos
authors.forename: F
authors.initials: F
authors.lastname: Adamidou
authors.forename: A
authors.initials: A
authors.lastname: Slavakis
authors.forename: M
authors.initials: M
authors.lastname: Sapranidis
authors.forename: I D
authors.initials: ID
authors.lastname: Litsas
authors.forename: S
authors.initials: S
authors.lastname: Katergari
authors.forename: D
authors.initials: D
authors.lastname: Selalmatzidou
authors.forename: M
authors.initials: M
authors.lastname: Kita
mesh_terms: D000172:Acromegaly / Q000150:complications / Q000473:pathology / Q000628:therapy*; D000236:Adenoma / Q000378:metabolism* / Q000473:pathology / Q000628:therapy; D000328:Adult; D001786:Blood Glucose / Q000378:metabolism; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D019382:Human Growth Hormone / Q000378:metabolism*; D006801:Humans; D007334:Insulin-Like Growth Factor I / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D010911:Pituitary Neoplasms / Q000378:metabolism* / Q000473:pathology / Q000628:therapy; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose; D019382:Human Growth Hormone; D007334:Insulin-Like Growth Factor I