Can acromegaly be cured? A twenty year review

ABSTRACT

A retrospective review was performed on 41 patients under going transphenoidal surgery for treatment of acromegaly between 1977 and 1997. The mean age was 16.9 years (range 8-67). There were 28 (68.3 percent) male subjects. The mean follow-up was 4.4 years (range 0-17 years). 14 (34.1 percent) patients underwent postoperative adjuvant treatment with radiotherapy, bromocriptine or both. Three (7.3 percent) patients required a second transphenoidal procedure for persistent disease. Postoperatively 27 (65.9 percent) patients (3 had unknown postoperative growth hormone levels) had normalisation of growth hormone (GH) levels (<5 ng/ml). Of these, 5(20.8 percent) of 24 patients (excluding 3 who were lost to follow-up) had biochemical recurrence of disease. This yields surgical cure in 22 (57.9 percent) of 38 patients (excluding the three who were lost to follow-up). Of the fourteen patients who underwent adjuvant treatment 6 (42.3 percent) attained GH levels <5 ng/ml. Considering all treatments combined, 26 (74.3 percent) of 35 patients (6 lost to follow-up) achieved biochemical cure. These results compare favourably with previously reported cure rates in the literature. Transphenoidal surgery is the initial treatment of choice for acromegaly. An overview of the management of this fascinating neuroendocrine disorder will be presented.(AU)