The Joint Annual Scientific Meetings of the Endocrine Society of Australia and the Society for Reproductive Biology 2018

Clinical characterisation of patients with Acromegaly: A single centre experience (#271)

Angeline Shen 1 , James King 2 , Sourav Das 3 , Christopher Yates 1 , Peter Colman 1
  1. Dept Diabetes & Endocrinology, Royal Melbourne Hospital, Parkville, Melbourne
  2. Royal Melbourne Hospital, Melbourne, VIC, Australia
  3. The Epicenter, Melbourne Health, Melbourne, Victoria, Australia

Introduction: Acromegaly leads to unfavourable metabolic complications and mortality.[1] The aim of this study was to clinically characterize patients with acromegaly and to examine outcomes. 

 Method:  All histories of patients with treated acromegaly at a single tertiary hospital between 1970-2017 were reviewed. 

Results: Sixty-eight patients were included.  Thirty-one patients (45%) were females and the mean age at diagnosis was 45 years (IQR 37-56). A high proportion of patients (81%) had macro-adenomas and 6 (9%) had tumours that co-secreted prolactin and growth hormone.  The most common symptoms reported were altered facial appearance (85%), enlargement of hands and feets (81%) and headache (57%).  Hypertension (38%), diabetes mellitus (24%) and sleep apnoea (22%) were also frequently reported.  Hypogonadism (testosterone level < 6nmol/L) was present in 32% of males, although osteoporosis was uncommon (3%). Fifty-four patients (79%) had long-term clinical outcome documented with a mean follow-up period of 13 years (IQR 4.7-22.7). Mortality was low (9%).  Following initial surgery, sustained remission was achieved in 23 patients (43%), ten patients (19%) had disease relapse and 25 patients (46%) had persistent disease requiring adjuvant medical and/or radiotherapy.  In total, eleven patients required more than one operation and 23 patients (42.6%) received radiotherapy.   The incidence of SIADH (4%), CSF leak (4%) and diabetes insipidus (6%) were low post initial surgery, however 16 (30%) developed DI after subsequent surgery.  Sixteen patients (30%) required long term thyroxine replacement, 12 (22%) needed cortisol replacement and 13 males (45%) received testosterone replacement.  Initial IGF-1 level but not GH level was negatively associated with remission rate post initial surgery.  (OR 0.51, p value=0.05)


Conclusion:  Macroadenomas were common amongst patients with acromegaly at this centre and metabolic complications such as hypertension, diabetes mellitus and sleep apnoea were prevalent.  Initial IGF-1 level but not GH-level was negatively associated with long-term remission post initial surgery.

  1. 1. Bolfi, F., et al., Mortality in Acromegaly decreased in the last decade: A Systematic Review and Meta-Analysis. Eur J Endocrinol, 2018.