title: Medical Treatment for Acromegaly does not Increase the Risk of Central Adrenal Insufficiency: A Long-Term Follow-Up Study.
abstract: Central adrenal insufficiency (CAI) in acromegaly may be related to pituitary adenoma or induced by various medical treatments, transsphenoidal neurosurgery (TNS) or radiotherapy (RT), alone or combined. We assessed the role of all available treatments for acromegaly in inducing CAI. We retrospectively studied 97 patients. CAI was diagnosed if morning serum cortisol was <138 nmol/l, or if its response was inadequate in the low-dose short synacthen test. Seventy-four subjects underwent TNS (and 17 of whom also underwent RT), and 23 were on primary medical therapy: overall we diagnosed 21 cases of CAI. Duration of acromegaly, invasion of cavernous sinus, disease control, and type of medical treatment were much the same for patients with and without CAI, which was identified in 18% of patients (10/57) after one TNS, and in 53% (9/17) after RT (p=0.01); repeat surgery increased the risk of CAI (p=0.02). The risk of CAI onset during the follow-up was lower among patients treated with TNS or medical therapy than after RT (p=0.035). Medical treatment did not raise the risk of CAI, whereas a 5- and 4-fold higher risk of CAI was associated with repeat TNS and RT, respectively. Basal or stimulated cortisol levels were similar among acromegalic patients without CAI and matched controls with nonsecreting pituitary lesions. A significant proportion of patients with acromegaly developed CAI over time. While primary or secondary medical treatment did not contribute to the risk of CAI, repeat TNS and RT correlated with pituitary-adrenal axis impairment.
authors.affiliation: Department of Medicine DIMED, Endocrinology Unit, University Hospital of Padova, Padova, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Ceccato
authors.affiliation: Department of Medicine DIMED, Endocrinology Unit, University Hospital of Padova, Padova, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Lizzul
authors.affiliation: Department of Medicine DIMED, Endocrinology Unit, University Hospital of Padova, Padova, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Zilio
authors.affiliation: Department of Medicine DIMED, Endocrinology Unit, University Hospital of Padova, Padova, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Barbot
authors.affiliation: Department of Neurosciences DNS, Neurosurgery, University Hospital of Padova, Padova, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Denaro
authors.affiliation: Otorhinolaryngology and Otologic Surgery, University Hospital of Padova, Padova, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Emanuelli
authors.affiliation: Neurosurgical Division, University Hospital of Padova, Padova, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Alessio
authors.affiliation: Neuroradiology Unit, University Hospital of Padova, Padova, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Rolma
authors.affiliation: Department of Medicine and Surgery, Neuroradiology, University of Salerno, Salerno, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Manara
authors.affiliation: Department of Medicine DIMED, Internal Medicine, University Hospital of Padova, Padova, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Saller
authors.affiliation: Department of Medicine DIMED, Endocrinology Unit, University Hospital of Padova, Padova, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Boscaro
authors.affiliation: Department of Medicine DIMED, Endocrinology Unit, University Hospital of Padova, Padova, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Scaroni
mesh_terms: D000172:Acromegaly / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D000309:Adrenal Insufficiency / Q000097:blood / Q000209:etiology*; D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007030:Hypothalamo-Hypophyseal System / Q000473:pathology; D015993:Life Tables; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010913:Pituitary-Adrenal System / Q000473:pathology; D012307:Risk Factors; D013997:Time Factors
chemical_list: D006854:Hydrocortisone