Long-term treatment outcomes of acromegaly patients presenting biochemically-uncontrolled at a tertiary pituitary center - PubMed (original) (raw)

Long-term treatment outcomes of acromegaly patients presenting biochemically-uncontrolled at a tertiary pituitary center

John D Carmichael et al. BMC Endocr Disord. 2017.

Abstract

Background: Acromegaly is a rare, slowly progressive disorder resulting from excessive growth hormone (GH) production by a pituitary somatotroph tumor. The objective of this study was to examine acromegaly treatment outcomes during long-term care at a specialized pituitary center in patients presenting with lack of biochemical control.

Methods: Data came from an acromegaly registry at the Cedars-Sinai Medical Center Pituitary Center (center). Acromegaly patients included in this study were those who presented biochemically-uncontrolled for care at the center. Biochemical control status, based on serum insulin-like growth factor-1 values, was determined at presentation and at study end. Patient characteristics and acromegaly treatments were reported before and after presentation by presenting treatment status and final biochemical control status. Data on long-term follow-up were recorded from 1985 through June 2013.

Results: Seventy-four patients presented uncontrolled: 40 untreated (54.1%) and 34 (45.9%) previously-treated. Mean (SD) age at diagnosis was 43.2 (14.7); 32 (43.2%) were female patients. Of 65 patients with tumor size information, 59 (90.8%) had macroadenomas. Prior treatments among the 34 previously-treated patients were pituitary surgery alone (47.1%), surgery and medication (41.2%), and medication alone (11.8%). Of the 40 patients without prior treatment, 82.5% achieved control by study end. Of the 34 with prior treatment, 50% achieved control by study end.

Conclusions: This observational study shows that treatment outcomes of biochemically-uncontrolled acromegaly patients improve with directed care, particularly for those that initially present untreated. Patients often require multiple modalities of treatment, many of which are offered with the highest quality at specialized pituitary centers. Despite specialized care, some patients were not able to achieve biochemical control with methods of treatment that were available at the time of their treatment, showing the need for additional treatment options.

Keywords: Acromegaly; Biochemical control; Insulin-like growth factor-1; Patient registry; Treatment.

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Conflict of interest statement

The study was approved by the Cedars-Sinai Medical Center Institutional Review Board. Written informed consent was obtained from all individual participants included in the study.

Not applicable.

Competing interests

Vivien Bonert, John D. Carmichael, and Adam Mamelak were responsible for overseeing this study at Cedars-Sinai Medical Center, which received funding for this research. Maureen Neary and Qayyim Said are employees of Novartis Pharmaceuticals Corporation. Michael S. Broder, Eunice Chang, and Dasha Cherepanov are employees of Partnership for Health Analytic Research, LLC, a health services research company paid by Novartis to conduct this research. Dr. John D. Carmichael is currently located at the University of Southern California (USC) Pituitary Center at the Keck School of Medicine of USC.

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