Clinical Characteristics, Treatment and Morbidity in Acromegaly: Findings From a Medium Country

Acromegaly is a rare chronic disease caused by excess secretion of growth hormone (GH), which leads to an increased production of insulin-like growth factor-1 (IGF-1). Due to its low prevalence, data on patient outcome and risk factors are still limited. The aim objective of the present study was to describe the clinical characteristics and morbidity in a cohort of Colombian adults with acromegaly.

Methods:

Retrospective, cross-sectional study. Data from patients with diagnosis of acromegaly from 2015 to 2021 were extracted from an electronic database.

Results:

59 subjects were included. Mean age was 56.3±12.9 years. n=38 (64.4%) were women. Median GH levels were 1.4 ng/mL (IQR 8.6), median IGF-1 levels were 292 ng/mL (IQR 358) and median of fasting glucose was 99 mg/dL (IQR 20). Pituitary surgery was performed in n=51 (86.4%) patients. Of these, 11 (21.5%) were operated twice or more, as a result of uncontrolled or recurrent disease. Conventional radiotherapy was selected for 11 subjects (18.6%). On the other hand, n=41 (69.5%) was treated with somatostatin analogs (SSAs). The majority of them received lanreotide n=21 (51.21) followed by octreotide n=19 (46.3%), and one subject pasireotide (2.4%). Dopamine agonist (AD) was the exclusive pharmacotherapy in n=5 (8.5%) patients, n=8 (13.5%) were treated with AD plus SSAs. Combination of neurosurgery and pharmacotherapy was reported in 20 patients (33.9%) and neurosurgery, radiotherapy and pharmacotherapy in 7 subjects. The most common comorbidity was arterial hypertension in 42.4% of cases. Arthropathy was reported in 16.9% and carpal tunnel in 20.3% of the patients. Osteoporosis and osteopenia were found in 13.6% and 2.4% of the cases in which bone densitometry was performed, respectively. In the subgroup with osteoporosis, n=2 had vertebral fracture. Diabetes mellitus was reported in 39% of cases and dyslipidemia in a 37.3%. Sleep apnea was confirmed in 27.1% of patients using a polysomnography. The colonoscopy, reported adenomatous polyps in 5 subjects, thyroid ultrasound found goiter in 20.3% of cases and thyroid nodules in 16.9% of the patients. Cardiovascular morbidity, such as valvular heart disease, left ventricular hypertrophy, and heart failure was presented in the 13,6%, 6,8% and 5.1% of patients, respectively. In the subgroup of patients whom echocardiography test was performed (n=23) the mean of left ventricular ejection fraction was 54±18.7%. Finally, hypopituitarism was found in the 15.3% of cases.

Discussion/Conclusion:

Our study, highlight the significant impact that have the acromegaly in terms of morbidity. Recognizing the clinical, biochemical and treatment characteristics of the patients, contributes to the understanding of this pathology, which facilitates an early diagnosis and reduces barriers to treatment and mortality.