Diagnostic characteristics and therapeutic responses in acromegaly: The liege acromegaly survey

Aims: The diagnosis and treatment of acromegaly have undergone various refinements over time due a combination of increased understanding of the pathophysiology of the disease and the introduction of new techniques and therapies. Information on the characteristics of acromegalic patients is traditionally derived from clinical trials; data generated from experience in the setting of everyday management at large clinical centers remains relatively scant.

Methods: Using a proprietary electronic database developed by Graphmed Ltd., we evaluated the demographic, clinical, hormonal/biochemical and radiological characteristics of acromegalic patients treated from 1952–2005 in the Departments of Endocrinology and Neurosurgery of the CHU de Liège and ancillary hospital facilities. Pre-designated data on individual patients were retrieved from case files, radiological images, surgical notes and pathology reports; these data were entered into the Liège Acromegaly Survey database and underwent statistical analysis.

Results: The Survey database included 197 acromegalic patients (101M/96F) as of 10/2005. The mean age at diagnosis was 44.1±13.6 years (range 12–72 years); the duration of diagnosed acromegaly ranged from 1–30 years. Patients were classified as sporadic (188), familial (5), McCune-Albright syndrome (2) or MEN-1 (2). In patients with valid radiological data, 78% had macroadenomas. Mean GH and IGF-I levels at diagnosis were higher in younger (<30yr) versus older patients (>65yr). Hormonal control was achieved in 78% of patients overall. Post-treatment hypopituitarism occurred in 35 (17.8%) patients: 1 axis (11), 2 axes (6), 3 axes (15), complete (3).

Conclusion: Organized assessment of the characteristics and response to therapy of patients with acromegaly treated in the clinical setting can help to confirm the findings of clinical trials. GH and IGF-I at diagnosis was higher at young patients than in older patients and hormonal control was achieved in 78% of patients overall. The prevalence of hypopituitarism post-therapy was low in this series.