Factors Affecting Prognosis in a Series of Acromegalic Patients

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: SUN 88-129-Acromegaly & Prolactinoma
Clinical
Sunday, June 16, 2013: 1:45 PM-3:45 PM
Expo Halls ABC (Moscone Center)

Poster Board SUN-111
Francesca Lugli*1, Alessandra Fusco1, Antonio Bianchi1, Donato Iacovazzo1, Antonella Giampietro1, Domenico Milardi1, Sabrina Chiloiro1, Serena Piacentini1, Linda Tartaglione1, Francesco Doglietto1, Carmelo Anile1, Giulio Maira1 and Laura De Marinis2
1Catholic University, Rome, Italy, 2Catholic University School of Medicine, Rome, Italy
Introduction: the main goal in the treatment of acromegaly is achieving biochemical control, as to prevent the wide range of cardiovascular, respiratory and metabolic comorbidities. Few data are available about factors affecting prognosis and response to medical treatment.

Materials and methods: we describe a series of 118 patients diagnosed with GH-secreting pituitary adenoma (24 microadenomas, 94 macroadenomas), all submitted to surgery as first line treatment. All patients with persistent disease after surgery have been treated with somatostatin analogues (SSA). We analyzed GH and IGF-1 levels, tumor size and invasiveness, Ki-67 labeling and correlated these findings with prognosis and response to medical treatment.    

Results: twenty-eight/118 patients (23.7%) were considered biochemically cured after surgery: these patients had more frequently microadenomas (65 vs 18%) with lower Ki-67 (1.2 vs 1.7) and cavernous sinus involvement (4 vs 46%) compared to patients with persistent disease after surgery. There were no differences among these two groups of patients regarding basal GH and IGF-1 levels. Among the 90 patients treated with SSA, 64 (71.1%) were biochemically controlled. Patients with disease resistant to SSA presented more frequently cavernous sinus involvement (65 vs 29%) and higher Ki-67 (2.4 vs 1.5%) compared to SSA responsive patients. GH and IGF-1 levels did not differ significantly between SSA responsive and SSA resistant patients.  

Conclusion: our data show that tumor size, local invasiveness and Ki-67 labeling are all prognostic factors in pituitary GH-secreting adenomas. The apparently low percentage of patients with biochemical remission after surgery probably reflect the high proportion of macroadenomas in our series, considering that our is a tertiary referral center for pituitary diseases.

Nothing to Disclose: FL, AF, AB, DI, AG, DM, SC, SP, LT, FD, CA, GM, LD

*Please take note of The Endocrine Society's News Embargo Policy at http://www.endo-society.org/endo2013/media.cfm