Characteristics, Comorbidities, and Outcomes in Acromegalic Patients Treated at a Swiss Tertiary Referral Center

Aim: The aim of this study was to gain an insight into the characteristics, treatment modalities, and comorbidities in patients with acromegaly who were referred to the Kantonsspital Aarau.

Methods: Patients were either operated at the Department of Neurosurgery or referred to the Department of Endocrinology in the Kantonsspital Aarau between 2006 and 2016. Patient data were first recorded in a multicenter registry initiated by the Kantonsspital Aarau (SwissPit) and subsequently analyzed. 21 patients with acromegaly were retrospectively screened to be included in the study. The diagnosis of acromegaly was indicated by laboratory results and further validated by neuroradiological findings. Remission was defined as the normalization of IGF-1 and normal random human growth hormone (hGH) levels.

Results: The most prevalent symptoms present at diagnosis were acral enlargement (n = 17, 81%), headaches (n = 6, 29%), macroglossia (n = 6, 29%) and visual field defects (n = 4, 19%), while the most prevalent comorbidities were arterial hypertension (n = 14, 67%), carpal tunnel syndrome (n = 8, 38%), obesity (n = 7, 33%), and diabetes mellitus type 2 (n = 5, 24%). The mean age was 48.9 years (14.9 SD), the median initial IGF-1 level was 440 µg/L (IQR: 101–639) and the median initial hGH-level was 25.7 µg/L (IQR: 6.34–34.85). Out of the 19 (90%) patients who received initial surgical treatment, 5 (26%) remained uncontrolled, 6 (32%) went into remission with ongoing medical treatment, and 8 (42%) went into complete remission without ongoing medical treatment. Invasion of the cavernous sinus (Knosp grade 3 and 4) was a significant predictor for non-curative surgery (p = 0.01).

Conclusions: Successful management of acromegaly goes beyond treatment of the disease itself and includes careful screening for commonly associated comorbidities. Remission after surgery is strongly dependent on invasive tumor growth; in case of disease persistence, a multimodal approach using drug and radiotherapy is necessary.

No conflict of interest has been declared by the author(s).