Monitoring of patients with acromegaly in the real-life clinical practice settings

Background. Acromegaly is a severe chronic disease caused by hyperproduction of somatotropic hormone (GH), which significantly affects the quality and duration of life. Growth hormone hyperproduction leads to the development of severe comorbid diseases, including deformation of the axial skeleton, osteoarthritis, cardiovascular diseases, carbohydrate metabolism disorders, and some types of cancer. Compared to the general population, in patients with active acromegaly, early disability and an increase in mortality are noted. Objective. Estimation of the time of the last visit to the expert center for patients with acromegaly in the Moscow region, as well as the proportion of patients with controlled and uncontrolled acromegaly at the time of the last visit, and analysis of the types of treatment performed. Methods. A retrospective observational study was conducted. According to the data of the M.F. Vladimirsky Moscow Regional Research Clinical Institute, there are 377 patients with acromegaly in the Moscow region. For the analysis, medical records of 327 patients with acromegaly observed in the M.F. Vladimirsky Moscow Regional Research Clinical Institute were selected. Controlled acromegaly was defined as a condition with the growth hormone level <2.5 ng/ml, and the insulin-like growth factor 1 (IGF-1) level within the age and gender reference range (except for patients receiving pegvisomant, in such cases only IGF- 1 level was taken into account). Results. The mean age of patients at the time of diagnosis was 49±14.1 years. The majority (52%) of patients were diagnosed between the ages of 41 and 60 years. The number of women (252 patients, 77%) was significantly higher compared to the number of men (75 patients, 23%). At the last visit, the mean age of the patients was 58±13.4 years; 171 (52.3%) patients had controlled acromegaly, 155 (47.4%) patients had uncontrolled acromegaly, and 1 (0.3%) patient had no evidence of acromegaly control at the last visit. In general, 56.6% of patients received neurosurgical treatment, 65.7% of patients received drug treatment, 27.5% of patients received somatostatin analogues as the first line of treatment, and 18.7% of patients received radiation treatment. The analysis made it possible to reveal that 50.8% of patients have not visited the endocrinologist of the CDC of the M.F. Vladimirsky Moscow Regional Research Clinical Institute since 2019 (inclusive). At the same time, half of them (50.6%) were without control of the underlying disease at the time of the last visit. Conclusions. It is recommended to consider the use of neurosurgical intervention in patients with acromegaly in all possible cases, especially if the disease remains active during therapy with somatostatin analogues at maximum dosages. Taking into account, in general, the accumulated experience of many years of use and the favorable efficacy/safety profile of somatostatin analogues, it is advisable to start drug therapy in individuals without achieving the target hormonal criteria for controlling acromegaly either immediately with high dosages, or by rapidly increasing the dose to the maximum possible.

acromegaly, foloow-up of patients with acromegaly, somatotropinoma, insulin-like growth factor 1, somatotropinoma, octreotide, lanreotide, cabergoline, pegvisomant