Category: Pituitary Disorders/Neuroendocrinology

Monitor: 31

31 - Clinical Audit in Acromegaly in a Reference Neuroendocrinology Service of Public Health of the Northeast of Brazil

Saturday, Apr 27
10:30 AM – 11:00 AM

Objective : To describe an auditory study of acromegaly, correlating hormonal levels with laboratory characteristics and evaluation of comorbidities.


Methods : Series of cases of acromegalic patients, with information collected in medical records.


Results : the sample consisted of 30 patients, with a mean age at diagnosis of 41.8 ± 11.75 years. The mean tumor size was 2.45cm. GH values at diagnosis ranged from 1.8 to 52ng / mL, with an average of 17.7ng / mL; and IGF-1 ranged from 289 to 1867ng / mL, with a mean of 851.8ng / mL. Patients were divided by tumor size in the 50th percentile (2cm) and correlated with GH, IGF-1 and age values.


Discussion : In the larger tumor group, there were higher values of GH (p = 0.01), tendency to higher IGF-1 (p = 0.06) and lower age (p = 0.07). In total, 27 patients underwent surgery, 26 patients underwent clinical treatment, with 23 using somatostatin analogs (AS) [Octreotide (21) and Lanreotide (2)], 3 using cabergoline (CAB) alone, and 13 in association. In four patients, new surgery was indicated and five patients underwent radiotherapy. 12 patients were considered controlled. There was no difference between the controlled and uncontrolled group regarding GH levels, age, tumor size; however, in the controlled patients there was a trend towards lower IGF-1 levels (p = 0.056). 14 patients are diabetic, 9 pre-diabetic, 21 hypertensive and 23 dyslipidemic. Control patients had lower values of fasting blood glucose (p=0,05) and low intensity cholesterol fraction (p=0,01); with no difference in glycated hemoglobin, high cholesterol fraction and triglycerides. The echocardiogram was performed in 23 patients with left atrial enlargement (3), left ventricular hypertrophy (5), mitral insufficiency (6), tricuspid insufficiency (1), aortic insufficiency (4), septal hypokinesia in LV and aortic ectasia (1). Thyroid ultrasonography was performed in 26 patients, with carcinoma papillary (2) and follicular neoplasia (2). The percentage of thyroid neoplasia among the acromegalic with nodules was 18,8%. 24 patients underwent colonoscopy, with colonic polyps found in 9 patients. Histological analysis revealed: hyperplastic polyps (5) and low grade dysplasia (2), without any case of cancer.


Conclusion :

We found a higher risk of metabolic complications in acromegalic and low percentage of control, despite the multifactorial treatment. Audit studies are important for assessing disease control and screening for complications.

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Aline ALVES.. Lopes

doctor
Agamenon Magalhaes Hospital
João Pessoa, Paraiba, Brazil

medica residente em endocrinologia, HAM, SUS, PE

Sérgio RICARDO.. Andrade

medico
md

medico residente em endocrinologia, HAM, SUS, SES, PE

Daniella Maria Carneiro Rego

medica
MD

Medica preceptora em Endocrinologia, Hospital Agamenon Magalhaes

Francisco Bandeira

MEDICO
MD, PhD

MEDICO PRECEPTOR DE ENDOCRINOLOGIA, HAM, SUS, SES, PE