Acromegaly treatment in Romania. How close are we to disease control?
Abstract
Introduction: In Romania, no nationwide data for acromegaly treatment and control rate are available. Our objective was to assess the acromegaly control rate in a tertiary referral centre, which covers an important part of Romanian territory and population of patients with acromegaly.
Materials and methods: We reviewed the records of all 164 patients (49 males and 115 females; median age 55 [47, 63.5] years) with newly or previously diagnosed acromegaly, who have been assessed at least once in our tertiary referral centre between January 1, 2012 and March 31, 2016. This sample represents 13.6% of the total expected 1200 Romanian patients with acromegaly and covers 82.9% of the counties in Romania. Control of acromegaly was defined as a random serum growth hormone (GH) < 1 ng/mL and an age-normalised serum insulin-like growth factor-I (IGF-I) value. The GH and IGF-I values used for calculation of the control rate were those at the last evaluation. The same assays for GH and IGF-I measurement were used in all patients.
Results: There were 147 treated and 17 untreated patients. Of the 147 patients assessed after therapy, 137 (93.2%) had pituitary surgery, 116 (78.9%) were on medical treatment at the last evaluation, and 67 (45.5%) had radiotherapy. Seventy-one (48.3%) had a random GH < 1 ng/mL, 54 (36.7%) had a normalised, age-adjusted IGF-I, and 42 (28.6%) had both normal random serum GH and IGF-I.
Conclusions: In Romania, acromegaly benefits from the whole spectrum of therapeutic interventions. However, the control rate remains disappointing.
Keywords: acromegalyRomaniatreatmentcontrol rate
References
- Sherlock M, Ayuk J, Tomlinson JW, et al. Mortality in patients with pituitary disease. Endocr Rev. 2010; 31(3): 301–342.
- Melmed S, Colao A, Barkan A, et al. Acromegaly Consensus Group. Guidelines for acromegaly management: an update. J Clin Endocrinol Metab. 2009; 94(5): 1509–1517.
- Murray RD, Melmed S. A critical analysis of clinically available somatostatin analog formulations for therapy of acromegaly. J Clin Endocrinol Metab. 2008; 93(8): 2957–2968.
- Tritos NA, Biller BMK. Pegvisomant: a growth hormone receptor antagonist used in the treatment of acromegaly. Pituitary. 2017; 20(1): 129–135.
- Schöfl C, Franz H, Grussendorf M, et al. participants of the German Acromegaly Register. Long-term outcome in patients with acromegaly: analysis of 1344 patients from the German Acromegaly Register. Eur J Endocrinol. 2013; 168(1): 39–47.
- Bex M, Abs R, T'Sjoen G, et al. AcroBel--the Belgian registry on acromegaly: a survey of the 'real-life' outcome in 418 acromegalic subjects. Eur J Endocrinol. 2007; 157(4): 399–409.
- Howlett TA, Willis D, Walker G, et al. UK Acromegaly Register Study Group (UKAR-3). Control of growth hormone and IGF1 in patients with acromegaly in the UK: responses to medical treatment with somatostatin analogues and dopamine agonists. Clin Endocrinol (Oxf). 2013; 79(5): 689–699.
- Gheorghiu ML, Găloiu S, Vintilă M, et al. Beneficial effect of dose escalation and surgical debulking in patients with acromegaly treated with somatostatin analogs in a Romanian tertiary care center. Hormones (Athens). 2016; 15(2): 224–234.
- Sesmilo G, Gaztambide S, Venegas E, et al. REA investigators. Changes in acromegaly treatment over four decades in Spain: analysis of the Spanish Acromegaly Registry (REA). Pituitary. 2013; 16(1): 115–121.
- Kauppinen-Mäkelin R, Sane T, Reunanen A, et al. A nationwide survey of mortality in acromegaly. J Clin Endocrinol Metab. 2005; 90(7): 4081–4086.
- Katznelson L, Laws ER, Melmed S, et al. Endocrine Society. Acromegaly: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2014; 99(11): 3933–3951.
- Holdaway IM, Rajasoorya C. Epidemiology of acromegaly. Pituitary. 1999; 2(1): 29–41.
- Freda PU, Katznelson L, van der Lely AJ, et al. Long-acting somatostatin analog therapy of acromegaly: a meta-analysis. J Clin Endocrinol Metab. 2005; 90(8): 4465–4473.
- Laws ER. Surgery for acromegaly: evolution of the techniques and outcomes. Rev Endocr Metab Disord. 2008; 9(1): 67–70.
- Bates PR, Carson MN, Trainer PJ, et al. UK National Acromegaly Register Study Group (UKAR-2). Wide variation in surgical outcomes for acromegaly in the UK. Clin Endocrinol (Oxf). 2008; 68(1): 136–142.
- Erturk E, Tuncel E, Kiyici S, et al. Outcome of surgery for acromegaly performed by different surgeons: importance of surgical experience. Pituitary. 2005; 8(2): 93–97.
- Galoiu S. Mortality of Patients with Acromegaly FROM a Tertiary National Neuroendocrine Center. Acta Endocrinologica (Bucharest). 2015; 11(4): 476–481.