Retrospective documentation and treatment results of our patients with acromegaly

Aims We aimed to document the data of acromegalic patients in means of their demographic data, symptoms, treatment modalities, complications and remission who were followed in our Endocrinology and Metabolic Diseases Clinic of Inonu University Medical Faculty, between 2009-2014. Materials and methods Forty four acromegalic patients were enrolled. Patients' s files were scanned retrospectively. Demographic characteristics, clinical and laboratory findings with radiological imagings were viewed. Treatment modalities and their results with remission rates were evaluated. Results The group was consisted of 28 (63.3%) female and 16 (36.36%) male patients. The mean age at time of diagnosis was 40±10.8 years for women and 37±14.7 for men. The real time mean age was 47.3±9.9 years for women, 44.3±13.4 years for men. Swollen soft tissue in means of physical findings was the most common compliance. Mild to moderate dyslipidemia and abnormal carbohydrate metabolism was defined. Hepatomegaly and gall bladder stones were common. Multinodulary goiter was the predominant thyroid lesion. Hypertension with echocardiographic left ventricular diastolic dysfunction was the other common disorders. Eleven patients had microadenomas and 33 patients had macroadenomas. Remission rate was 18.2% in patients with macroadenomas and 81.8% with microadenomas with a statistical significancy. Transsphenoidal surgery was performed to 35 patients (79.5%), and transcranial to 5 (11.3%) whreas 4 (9.2%) patients refused any surgical procedure. Seven (15.9%) patients were treated with somatostatin analogues preoperatively. Thirty three (75%) patients were treated with somatostatin analogues postoperatively. Dopamine agonists were added to somatostatin treatment in 17 patients (38.6%). As expected; postoperative additional somatostatin treatment was found to have a positive effect on remission, while in difficult cases -ignoring the values of prolactinemia- adding dopamine agonists were found to be superior on remission. Our remission rates were not very successful either with gammaknife radiosurgery or conventional radiotherapy. Conclusion Somatostatin analogue therapy with addition to transsphenoidal surgery is the most frequent treatment modality for acromegaly in our patients. Especially for treatment resistant cases somatostatin analogue therapy in combination with a dopamine agonist therapy was found to be effective. Gammaknife surgery was the most frequent additional treatment modality. It is clear that new studies and new medical treatment agents are needed to increase the rate of remission. Key words: Acromegaly, somatostatin analogue, dopamine agonist, transsphenoidal surgery, radiotherapy