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Incidentally detected acromegaly: single-center study of surgically treated patients over 22 years
  1. Erica Alexandra Giraldi1,
  2. Emir Veledar2,
  3. Nelson M Oyesiku3,
  4. Adriana G Ioachimescu3
  1. 1 Division of Endocrinology, Diabetes and Metabolism, Emory University School of Medicine, Atlanta, Georgia, USA
  2. 2 Baptist Health South Florida, Miami, Florida, USA
  3. 3 Division of Endocrinology, Diabetes and Metabolism, Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA
  1. Correspondence to Dr Adriana G Ioachimescu, Division of Endocrinology, Diabetes and Metabolism, Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA 30322, USA; aioachi{at}emory.edu

Abstract

Acromegaly is a rare disease associated with comorbidities that are common in the general population. Most patients undergo screening for classic phenotypical (CP) or mass effect manifestations. By retrospective review of pituitary tumor surgeries performed between 1994 and 2016 (1836), we identified patients with acromegaly (112). Main presentations were: CP (43%), mass effect (26%), incidentally detected (ID) tumors (17%), and other (14%). We compared the ID and CP groups regarding prevalence, clinical, biochemical, radiological and histopathological characteristics, and postoperative outcomes. The prevalence of ID among all surgeries increased after 2011 from 0.6% to 1.9% (p=0.01), while prevalence of CP remained stable (2.8% and 2.33%, p=0.65). Almost half of ID (47.4%) presented with otolaryngological manifestations. The ID and CP groups were similar regarding age, gender, comorbidities (hypertension, diabetes, hypopituitarism), tumor diameter and cavernous sinus invasion. Median insulin-like growth factor (IGF-1) and growth hormone (GH) levels were lower in the ID than CP (p<0.05 and p=0.07). Patients younger than 40 had smaller tumors in the ID than CP, while the opposite was true for older patients. The 3-month biochemical remission rates were similar (68% ID and 58% CP). A similar number of patients had normal IGF-1 at last follow-up (89.5% ID and 81.25% CP) after surgery alone and multimodality treatment. In conclusion, an increased number of patients with GH-secreting adenomas were ID in recent years. Education of physicians other than endocrinologists regarding presentation and comorbidity clustering may lead to an earlier diagnosis of acromegaly and improved outcomes.

  • pituitary diseases
  • endocrinology
  • adenoma
  • disease management
  • education
  • medical

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Footnotes

  • Contributors EAG and AGI were involved in the conceptualization, design, data acquisition and analysis, investigation and writing of the manuscript. EV was involved in the statistical analysis, review and editing of the manuscript. NMO was involved in the data curation, review and editing of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval This study was approved by the Emory Institutional Review Board (IRB Protocol No 00019648, Outcome Pituitary Project Database).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request. Emory Enterprise REDCap application was used for electronic data storage which is compliant with Emory’s HIPAA policies and procedures. Analyses based on the database by the Emory study investigators are approved by the Emory Institutional Review Board.

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