Persistent Acromegaly Treatment Patterns and Outcomes

Presentation Number: SUN 450
Date of Presentation: April 2nd, 2017

Diane Donegan*1, Anu Sharma1, Nicole M Iniguez Ariza2, Frederic Meyer1, Jamie Van Gompel1, Todd B Nippoldt1, John Atkinson1 and Dana Erickson1
1Mayo Clinic, Rochester, MN, 2Mayo Clnic, Rochester

Abstract

Introduction: Uncontrolled acromegaly is associated with increased morbidity, premature mortality and reduced quality of life; the risk of which can be eliminated by successful biochemical control. Despite multimodal therapeutic options, adequate control of the disease can be very challenging in some patients leading to prolonged exposure to growth hormone excess

Aim: To assess treatment patterns and outcomes in patients with persistent acromegaly following surgery at a single institution with all available modes of treatment.

Methods: A retrospective analysis of all patients with a new diagnosis of acromegaly at the Mayo Clinic in Rochester, MN from 1995-2015 who failed to achieve remission defined as a normal age adjusted IGF-I 3 -6 months after pituitary surgery at our institution. Medical records were reviewed to assess treatment modalities, outcomes and time to remission.

Results: A total of 135 patients (73 males, 62 females) with newly diagnosed acromegaly did not achieve remission following surgery. The mean age at diagnosis was 46 (±14) years and the average length of follow up was 5.5 (± 5) years. The median IGF-I level at diagnosis was 798 ng/ml (130-12,226) representing a mean 3.5 (± 1.4) fold above the age adjusted reference range and a median growth hormone of 12ng/ml (0.05- 483). The mean tumor size at diagnosis was 1.8 cm (± 1) and 47% (64/135) had clear cavernous sinus invasion on preoperative imaging. The most common second line treatment was radiotherapy (43%, 57/135) followed by medical therapy (30%, 40/135), repeat surgery (14%, 19/135) and observation in 13% (17/135). The median total number of treatments required to achieve remission was 3 (± 1) and median time to remission from diagnosis was 45 months (CI: 39-61). Remission was achieved in 75 patients (56%) at the last follow up visit. The median length of follow up among those with persistent disease was 3 years (0.5-20) compared to 5 years (0.5-21) for those who achieved remission. During follow up 7 patients died (the cause of death in 2 was cancer, stroke in 1, cardiovascular in 1 and in 3 the cause was unknown) with a median age at death of 56 (40-85) years, 4 of whom had persistent acromegaly.

Conclusion: In patients with persistent acromegaly following surgery, multiple treatment modalities are required to achieve remission with a median time to remission was approximately 4 years. Therefore prolonged treatment with multimodal therapy is required in this cohort suggesting that persistent acromegaly poses significant financial and disease burden.

 

Nothing to Disclose: DD, AS, NMI, FM, JV, TBN, JA, DE