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Horm Metab Res 2016; 48(08): 514-519
DOI: 10.1055/s-0042-103933
Endocrine Care
© Georg Thieme Verlag KG Stuttgart · New York

Medical Treatment for Acromegaly does not Increase the Risk of Central Adrenal Insufficiency: A Long-Term Follow-Up Study

F. Ceccato
1   Department of Medicine DIMED, Endocrinology Unit, University Hospital of Padova, Padova, Italy
,
L. Lizzul
1   Department of Medicine DIMED, Endocrinology Unit, University Hospital of Padova, Padova, Italy
,
M. Zilio
1   Department of Medicine DIMED, Endocrinology Unit, University Hospital of Padova, Padova, Italy
,
M. Barbot
1   Department of Medicine DIMED, Endocrinology Unit, University Hospital of Padova, Padova, Italy
,
L. Denaro
2   Department of Neurosciences DNS, Neurosurgery, University Hospital of Padova, Padova, Italy
,
E. Emanuelli
3   Otorhinolaryngology and Otologic Surgery, University Hospital of Padova, Padova, Italy
,
L. Alessio
4   Neurosurgical Division, University Hospital of Padova, Padova, Italy
,
G. Rolma
5   Neuroradiology Unit, University Hospital of Padova, Padova, Italy
,
R. Manara
6   Department of Medicine and Surgery, Neuroradiology, University of Salerno, Salerno, Italy
,
A. Saller
7   Department of Medicine DIMED, Internal Medicine, University Hospital of Padova, Padova, Italy
,
M. Boscaro
1   Department of Medicine DIMED, Endocrinology Unit, University Hospital of Padova, Padova, Italy
,
C. Scaroni
1   Department of Medicine DIMED, Endocrinology Unit, University Hospital of Padova, Padova, Italy
› Author Affiliations
Further Information

Publication History

received 08 December 2015

accepted 18 February 2016

Publication Date:
31 May 2016 (online)

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Abstract

Central adrenal insufficiency (CAI) in acromegaly may be related to pituitary adenoma or induced by various medical treatments, transsphenoidal neurosurgery (TNS) or radiotherapy (RT), alone or combined. We assessed the role of all available treatments for acromegaly in inducing CAI. We retrospectively studied 97 patients. CAI was diagnosed if morning serum cortisol was <138 nmol/l, or if its response was inadequate in the low-dose short synacthen test. Seventy-four subjects underwent TNS (and 17 of whom also underwent RT), and 23 were on primary medical therapy: overall we diagnosed 21 cases of CAI. Duration of acromegaly, invasion of cavernous sinus, disease control, and type of medical treatment were much the same for patients with and without CAI, which was identified in 18% of patients (10/57) after one TNS, and in 53% (9/17) after RT (p=0.01); repeat surgery increased the risk of CAI (p=0.02). The risk of CAI onset during the follow-up was lower among patients treated with TNS or medical therapy than after RT (p=0.035). Medical treatment did not raise the risk of CAI, whereas a 5- and 4-fold higher risk of CAI was associated with repeat TNS and RT, respectively. Basal or stimulated cortisol levels were similar among acromegalic patients without CAI and matched controls with nonsecreting pituitary lesions. A significant proportion of patients with acromegaly developed CAI over time. While primary or secondary medical treatment did not contribute to the risk of CAI, repeat TNS and RT correlated with pituitary-adrenal axis impairment.

Key words

acromegaly - hypopituitarism - central adrenal insufficiency - radiotherapy - neurosurgery

Supplementary Material

 

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