Acromegaly: a clinical perspective.

Autor: Lawrence L; Department of Endocrinology, Diabetes and Metabolism, Cleveland Clinic, 9500 Euclid Ave. F-20, Cleveland, OH 44195 USA., Alkwatli K; Department of Endocrinology, Diabetes and Metabolism, Cleveland Clinic, 9500 Euclid Ave. F-20, Cleveland, OH 44195 USA., Bena J; Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH USA., Prayson R; Department of Anatomic Pathology, Cleveland Clinic, Cleveland, OH USA., Kshettry V; Department of Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, OH USA., Recinos P; Department of Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, OH USA., Hatipoglu B; Department of Endocrinology, Diabetes and Metabolism, Cleveland Clinic, 9500 Euclid Ave. F-20, Cleveland, OH 44195 USA., Pantalone KM; Department of Endocrinology, Diabetes and Metabolism, Cleveland Clinic, 9500 Euclid Ave. F-20, Cleveland, OH 44195 USA., Weil R; Lifespan Physician Group, Rhode Island Hospital, Providence, RI USA., Hamrahian AH; Department of Endocrinology, Diabetes and Metabolism, Johns Hopkins University, Baltimore, MD USA., Kennedy L; Department of Endocrinology, Diabetes and Metabolism, Cleveland Clinic, 9500 Euclid Ave. F-20, Cleveland, OH 44195 USA., Yogi-Morren D; Department of Endocrinology, Diabetes and Metabolism, Cleveland Clinic, 9500 Euclid Ave. F-20, Cleveland, OH 44195 USA.
Jazyk: angličtina
Zdroj: Clinical diabetes and endocrinology [Clin Diabetes Endocrinol] 2020 Aug 20; Vol. 6, pp. 15. Date of Electronic Publication: 2020 Aug 20 (Print Publication: 2020).
DOI: 10.1186/s40842-020-00104-5
Abstrakt: Background: To examine the clinical and hormonal profiles, comorbidities, treatment patterns, surgical pathology and clinical outcomes of patients diagnosed with acromegaly at the Cleveland Clinic over a 15-year period.
Methods: A retrospective chart review of patients with acromegaly who underwent surgical resection between 2003 and 2018.
Results: A total of 136 patients (62 men; mean age 48.1 years) with biochemical evidence of acromegaly were analyzed. Median insulin-like growth factor 1 (IGF-1) level at diagnosis was 769.0 ng/mL and most patients had a macroadenoma (82.2%). Immunoreactivity to growth hormone (GH) was noted in 124 adenomas, with co-staining in 89 adenomas. Complete visible tumor resection during initial surgery was achieved in 87 patients (64.0%). In this cohort, complete response to surgery alone was observed in 61 patients (70.1%), while 31 out of 65 patients (47.7%) who received additional post-surgical medications and/or radiation therapy achieved complete response. At most recent follow-up, 92 patients achieved eventual complete response by documented normalization of IGF-1 levels. Higher IGF-1 level at diagnosis ( P  = 0.024) and cavernous sinus invasion ( P  = 0.028) were predictors for failure to respond to surgery.
Conclusion: In this study, the majority of tumors were macroadenoma, plurihormonal, and treated effectively with surgery alone or surgery with adjuvant medical or radiation therapy. More studies are needed to identify additional molecular biomarkers, tumor characteristics and imaging findings to individualize treatment and better predict treatment outcomes.
Competing Interests: Competing interestsThe authors declare that they have no competing interests.
(© The Author(s) 2020.)
Databáze: MEDLINE
Externí odkaz: