Introduction: Acromegaly leads to unfavourable metabolic complications and mortality. 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.