Category: Pituitary Disorders/Neuroendocrinology

Monitor: 27

27 - ACROMEGALY: THE 10-YEAR CLEVELAND CLINIC EXPERIENCE

Friday, Apr 26
11:00 AM – 11:30 AM

Objective :

To examine the clinical and hormonal profiles, comorbidities, treatment patterns, surgical pathology and clinical outcomes of patients diagnosed with acromegaly at the Cleveland Clinic over a 10-year period.


Methods :

A retrospective chart review of 86 patients with pituitary adenoma and biochemical evidence of acromegaly, who underwent surgical resection from January 2008 to August 2018.


Results : A total of 86 patients (43 men, 43 women; mean age 48.7 ± 14.3 years) were analyzed. Mean IGF-1 level at diagnosis was 810.81 ± 330.58 ng/mL. Most patients presented with a macroadenoma (77.6%) with mean tumor dimensions of 17.4 x 16.6 x 14.4 mm. Cavernous sinus invasion (39.3%) and optic chiasm compression (31.0%) were noted on MRI. Most patients received pre-medication with somatostatin analogs (SSA, 90.0%), dopamine agonists (DA, 8.3%), and 1 patient received pegvisomant (PEG). Growth hormone staining was noted in 79 adenomas (91.9%). Plurihormonal staining was observed in 56 adenomas (65.1%), including TSH (25.6%) and prolactin (15.1%). Cytokeratin staining performed in 23 patients revealed 17 densely (19.8%) and 6 sparsely (7.0%) granulated adenomas. Complete tumor resection during initial surgery was achieved in 64 patients (75.3%), with 60.9% of patients achieving normal IGF-1 levels at six months of follow-up. Eleven patients required repeat surgery, and 9 underwent irradiation. First-line medical therapy in patients who did not achieve surgical cure included SSA (75%) and DA (25%). Second-line therapy included SSA in 9 patients, DA in 7 patients and PEG in 5 patients. Third-line therapy included PEG in 7 patients and pasireotide in 1 patient. Overall, a significant majority of patients reported improvement in symptoms (93.4%) and comorbidities (79.6%) after treatment, although complete response to medication and radiation was only seen in 9 patients (28%) who did not achieve initial surgical cure.


Discussion : Our study describes the Cleveland Clinic experience with acromegaly over a 10-year period. While complete tumor resection was achieved with initial surgery in a majority of patients, a significant number required subsequent therapy with medications, repeat surgery and radiation.


Conclusion :

Although complete tumor resection was achieved with initial surgery in most patients, 21 out of 86 patients (25.5%) who did not achieve initial surgical cure, remained unresponsive to subsequent therapy with medications, repeat surgery and radiation. More sparsely granulated adenomas remained unresponsive to therapy in our cohort, which warrants further study. Our findings will afford clinicians a better understanding of acromegaly and variables that affect treatment and outcomes.

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Lima Lawrence

Endocrine Fellow
Cleveland Clinic
Cleveland Heights, Ohio

Endocrine Fellow at Cleveland Clinic

Kenda Alkwatli

Visiting Researcher
Cleveland Clinic

Visiting Researcher at Cleveland Clinic

James Bena

Principal Biostatistician
Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio.
Cleveland, Ohio

Lead Biostatistician, Quantitative Health Sciences, Cleveland Clinic

Varun Kshettry

Staff Neurosurgeon
Cleveland Clinic

Staff Neurosurgeon, Cleveland Clinic

Richard Prayson

Staff Pathologist
Cleveland Clinic

Staff Pathologist, Cleveland Clinic

Kevin Pantalone

Staff Endocrinologist
Cleveland Clinic

Staff Endocrinologist, Cleveland Clinic

Pablo F. Recinos

Staff Neurosurgeon
Cleveland Clinic
Cleveland, Ohio

Staff Neurosurgeon, Cleveland Clinic

Betul Hatipoglu

Staff Endocrinologist
Cleveland Clinic

Staff Endocrinologist, Cleveland Clinic

Laurence Kennedy

Chairman, Department of Endocrinology, Diabetes and Metabolism
Cleveland Clinic, Ohio

Chairman, Department of Endocrinology, Diabetes and Metabolism. Cleveland Clinic

Divya Yogi-Morren

Staff Endocrinologist
Cleveland Clinic

Staff Endocrinologist, Cleveland Clinic

Lima Lawrence

Endocrine Fellow
Cleveland Clinic
Cleveland Heights, Ohio

Endocrine Fellow at Cleveland Clinic