title: Outcome in acromegaly: A retrospective analysis.
abstract: BACKGROUND
  Many of the treatment modalities recommended for acromegaly are either too expensive or not available in large parts of India. There is a dearth of treatment and outcome data in Indian patients.
  
  
  OBJECTIVE
  The purpose of this study was to analyze the treatment modalities used and the respective outcomes which include remission, recurrence, hypopituitarism, other complications, and mortality.
  
  
  METHODS
  This is a retrospective data analysis of 15 acromegaly patients treated at a tertiary care hospital in eastern India. A remission criteria of nadir growth hormone level <1 μg/dl after Oral Glucose tolerance test (OGTT) and normal age related IGF-1 levels was used.
  
  
  RESULTS
  All patients (100%) had macroadenomas. Surgery could not be done in five (33%); three (19.8%) refused, two (13.2%) had comorbidities. Transsphenoidal surgery (TSS) achieved remission in four out of ten (40%). Conventional radiotherapy (CRT) failed in all five patients and caused hypopituitarisn in three (60%). Cabergoline (CAB) either alone or following surgery achieved remission in one out of four (25%) though symptomatic relief and tolerability were remarkable. One patient (7%) had pituitary apoplexy with remission, two patients (14.3%) died due to CVA.
  
  
  CONCLUSIONS
  TSS remains the treatment of choice in acromegaly, though in macroadenomas the success is limited. A sizeable proportion of patients refuse or are unfit for surgery. As most of the recommended options are very costly or unavailable, alternative treatment options generally used are CRT or CAB which have limited efficacy. Incidence of hypopituitarism, following CRT is very high.
authors.affiliation: Department of Endocrinology, KPC Medical College and Consultant Endocrinologist, Kolkata, India.
authors.forename: Debmalya
authors.initials: D
authors.lastname: Sanyal
authors.forename: Moutusi
authors.initials: M
authors.lastname: Raychaudhuri
keywords: Aacromegaly; cabergoline; radiotherapy; transsphenoidal surgery
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