Biochemical control in acromegaly with multimodality therapies: outcomes from a pituitary center and changes over time.

PURPOSE To determine the prevalence of IGF-1 normalization with long-term multimodality therapy in a pituitary center, and to assess changes over time. METHODS Patients with acromegaly (N=409), with >1-year of data after surgery, and at least two subsequent clinic visits, were included in long-term analysis (N=266). Biochemical data, clinical characteristics and therapeutic interventions were reviewed retrospectively. RESULTS At diagnosis, age was 43.4±14.3 years (mean±SD), BMI was 28.5 [24.9-32.1] kg/m2 [median, IQR], serum IGF-1 index (IGF-1 level/upper limit of normal) was 2.3 [1.7-3.1] and 80.5% had macroadenomas. Patients with TSS after 2006 were older [46.6±14.3 vs. 40.0±13.4 years, P< 0.001]. Age and tumor size correlated inversely. Overall (N=266), 93.2% achieved normal IGF-1 level during 9.9 [5.0-15.0] years with multimodality therapy. The interval to first normal IGF-1 level following failed surgical remission was shorter after 2006, 14.0 (95% confidence interval 10.0-20.0) vs. 27.5 (22.0-36.0) months (P=0.002). Radiation therapy (RT) and second surgery were rarer after 2006, 28 (22%) vs. 62 (47.0%), P<0.001 and 12 (9.4%) vs. 28 (21.2%), P=0.010, respectively. Age at diagnosis increased over time periods, possibly reflecting increased detection of acromegaly in older patients with milder disease. Male gender, older age, smaller tumor and lower IGF-1 index at diagnosis predicted long-term sustained IGF-1 control after surgery without adjuvant therapies. CONCLUSION The vast majority of patients with acromegaly can be biochemically controlled with multimodality therapy in the current era. Radiotherapy and repeat pituitary surgery became less frequently utilized over time. Long-term postoperative IGF-1 control without use of adjuvant therapies has improved.

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