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PubMed2000

Factors affecting the outcome of surgical treatment of acromegaly.

PURPOSE: To assess the results of and factors associated with the outcome of surgery for acromegaly. METHODS: We retrospectively examined the medical records of acromegalic patients who underwent trans-sphenoidal adenomectomy at our hospital during the period of January 1991 through August 1997. Preoperative evaluations included measurement of basal serum growth hormone (GH), insulin-like growth factor-I (IGF-I), prolactin (PRL), GH response to oral glucose, and GH and PRL response to bromocriptine, as well as pituitary magnetic resonance (MR) imaging. Postoperative evaluations included measurement of basal serum GH and IGF-I concentrations, and pituitary MR imaging. RESULTS: Thirty patients (14 men) with a mean age of 38 years were included. The mean follow-up period was 50 months (range, 15-90 mo). Ten of the 30 patients (33%) had early postoperative (1 mo after surgery) GH levels of less than 5 ng/mL. Twenty patients (67%) had final postoperative (last follow-up, 15-90 mo after surgery) GH levels of less than 5 ng/mL. Preoperative GH levels were positively correlated with early postoperative GH levels (r = 0.458, p = 0.011) and final postoperative GH levels (r = 0.479, p = 0.007). Early postoperative GH levels were also positively correlated with final postoperative GH levels (r = 0.595, p = 0.001). Tumor grade and stage were not significantly correlated with early or final postoperative GH levels. Thirteen of 21 patients (62%) who had postoperative MR imaging follow-up had residual tumor. There was no surgical mortality. CONCLUSIONS: These results highlight that acromegaly is not easily treated with surgery alone. The preoperative GH level was associated with the surgical outcome.

Acromegaly↗
PubMed1999

[Sleep apnea syndrome in acromegaly. Treatment and development-- retrospective analysis].

In total 56 subjects with acromegaly (37 men and 19 females) were examined in attempt to find sleep apnoea syndrome (SAS). The examination consisted of clinical examination and of all-night monitoring MESAM4 or polyMESAM. The diagnosis of SAS was established in 76.4% of subjects: 31 men and 11 females, average age 51.8 (SD +/- 9.6) years. The average ODI (oxygen desaturation index--number of oxygen saturation drops per 1 hour of sleep) of SAS patients was 29.2 (+/- 20.7). The therapy of SAS was recommended to 27 patients: sleeping position on the side (3 patients), reduction of the weight (8 patients), change of hypnotic drug (1 patient) and CPAP--continuous positive airway pressure (24 patients). CPAP titration was performed in 18 patients (in one subject the titration was repeated 4 years later). CPAP was titrated within all-night polysomnography in 10 subjects and in 9 subjects using self adjusting CPAP. Primary acceptance of CPAP was 94.4%. The average CPAP pressure was 7.8 (+/- 2.1) mbar. The theoretical duration of CPAP use was 546.6 (+/- 533.7) days. Long term compliance was considered as sufficient (weekly 25 hours or more) in 66.7% of patients. Ten patients underwent important acromegaly therapy or its change during the follow up and the improvement or the disappearance of SAS symptoms occurred in 6 of them.

Acromegaly↗
PubMed2000

[Acromegaly--diagnosis and treatment].

BACKGROUND: Acromegaly is a rare but clinically important disease caused by growth hormone hypersecretion, usually from a pituitary adenoma. The condition is associated with increased morbidity and mortality. MATERIAL AND METHODS: The prevalence of acromegaly is estimated to be 4-6 cases per million per year. The diagnosis is based on glucose-suppressed plasma growth hormone. When the diagnosis is confirmed, MR imaging of the pituitary gland is performed. RESULTS: Standard treatment is transsphenoidal microsurgery; however, radicality is often difficult because of extensive tumour growth. Preoperative administration of somatostatin analogues may improve the surgical outcome. INTERPRETATION: We have initiated a randomized, prospective study to elucidate this adjuvant treatment. Somatostatin analouges are required in the case of postoperative activity. This treatment is without tachyphylaxis and has few side effects. Alternatively, dopamine agonists such as bromocriptine can be used, especially in mixed tumours coproducing prolactin. Newer, more specific dopamine agonists are currently being evaluated. Radiation therapy may be required in large, unresectable tumours, but the effects are slow-acting, and almost all patients develop hypopituitarism. Gamma knife radiosurgery seems promising for stopping tumour growth as well as for decreasing excessive hormone production. However long-time follow-up results are so far lacking.

Acromegaly↗
PubMed1975

The treatment of acromegaly with special reference to trans-sphenoidal hypophysectomy.

Experience in the management of 100 cases of acromegaly is described. Three quarters of these had been referred directly to the endocrine clinic at the Middlesex Hospital. The remainder were referred from the Royal Post-graduate Hospital because they were thought unsuitable for yttrium implantation. The patients were studied by clinical assessment of severity, by measurement of basal growth hormone levels on three separate mornings, and by a review of possible complications. Particular attention was paid to diabetes, hypertension, cardiomegaly, respiratory, vascular and skeletal changes as well as visual field defect. Aggressive treatment was recommended in 77 patients. It was not recommended in the remainder on account of age, intercurrent illness or the apparent mildness of the condition. Fifty-nine patients were treated by trans-sphenoidal hypophysectomy. In 46 of the 59 patients the mean basal growth hormone level has been reduced to 5 ng/ml or less. In 39 this followed operation, in five operation and subsequent X-ray therapy and in two operation and the continuing effect of previously implanted yttrium. Of these 46 patients in whom the growth hormone level has been reduced to normal, 26 do not show any deficiency of anterior pituitary trophic hormones, 13 have gonadotrophin defect (in eight of these it was present before the operation) and seven require full replacement therapy. One patient died at home six weeks after the operation from a pulmonary embolus. There was one case of CSF rhinorrhoea which stopped spontaneously and three of acute frontal sinusitis. Trans-sphenoidal hypophysectomy is shown to be an effective means of treating acromegaly. If the basal level of growth hormone is not reduced to normal by six weeks after operation, it is recommended that a course of X-ray therapy should be given. This does not apply if irradiation has been used before operation.

Acromegaly↗
PubMed2001

[Acromegaly and sleep apnoea syndrome--case report].

We studied 65-year old, obese man suspected of obstructive sleep apnoea. He gave a history of loud snoring and excessive daytime sleepiness. We confirmed sleep apnoea syndrome during limited polysomnography with Polymesam (RDI--45/h, ODI--47/h). Patient had mainly obstructive episodes, however central and mixed apnoeas constituted about 1/3 of all episodes. During hospitalization we observed exacerbation of coronary artery disease and diagnosed diabetes. Patient's coarsened facial features, macroglossia and large hands led us to suspect acromegaly. Brain MR study revealed small pituitary adenoma. Plasma GH and IGF-1 concentrations were increased. Active acromegaly was diagnosed and was proposed a surgical treatment but he refused. Symptoms of sleep apnoea relieved after CPAP treatment. After one year patient's condition remained stable.

Acromegaly↗
PubMed2002

[Acromegaly, multinodular toxic goiter and papillary carcinoma of the thyroid, potential role of G proteins].

It is well known that non-toxic goiter is not uncommon in acromegaly, but hyperthyroidism only occasionally occurs. In addition, the risk for the development of a malignant process is increased, the most often seen is carcinoma of the colon. Thyroid carcinoma is not frequent, nevertheless the rate in these patients is higher than general population. In this article, a case of hyperthyroidism, papillar carcinoma and acromegaly is presented. We reviewed the literature an discussed the possible pathogenesis.

Acromegaly↗
PubMed2002

[Current alternative in the pharmacotherapy of acromegaly: the long-acting somatostatin analogue octreotide].

Twelve active acromegalic patients (10 women, 2 men) were chronically treated with a long-acting microcapsulated preparation of octreotide (Sandostatin LAR, Novartis). In each case, a growth hormone-producing pituitary adenoma was responsible for the development of acromegaly (microadenomas in 3 and macroadenomas in the rest of the patients). Treatment with long-acting octreotide was indicated for those patients who had not reacted satisfactorily upon previous therapeutic procedures or proved to be unsuitable for irradiation therapy and/or surgery or refused both of these therapies. The preparation was given intramuscularly in every fourth week, generally in a dose of 20-30 mg. After a 6-month treatment, the daily mean of serum growth hormone became suppressed below 2.5 ng/ml in 58.3% of the patients, whereas the growth hormone nadir during oral glucose tolerance test was found at or below 2.5 ng/ml in an even higher proportion of patients (70%). During a 2-year period, the growth hormone-suppressive effect of long-acting octreotide remained stable in all but one patient. The size of the pituitary adenomas remarkably decreased in 50% of this patient cohort. The medication with this preparation was well tolerated. As adverse events, asymptomatic cholelithiasis was detected in 2 patients and biliary sludge-formation in 1 patient. The total number of patients with glucose metabolism disturbances increased only moderately, however, the occurrence of manifest diabetes mellitus became doubled. On the basis of relevant literature data, it can be stated that the mortality rate of successfully treated acromegalics significantly improves. The present retrospective study yields evidence for the microcapsulated octreotide to be an effective tool in the modern therapy of acromegaly.

Acromegaly↗
PubMed2002

[Acromegaly associated with McCune-Albright syndrome].

McCune-Albright syndrome is characterized by polyostotic fibrous dysplasia, cafe au lait pigmentation of the skin, and multiple endocrinopathies. The authors report a history of a 30-years-old man who had a pathologic humerus fracture at the age of 14 years. The diagnosis of polyostotic fibrous dysplasia was established by radiologic examinations and bone biopsy. Fourteen years thereafter, active acromegaly due to a pituitary microadenoma was diagnosed using hormone measurements and pituitary magnetic resonance imaging. Pituitary surgery was refused because of an extensive skull involvement caused by the fibrous dysplasia. After an unsuccessful therapy with bromocriptine lasting three months, long-acting octreotide (Sandostatin LAR, Novartis) treatment was started. After a 12-months course of treatment, serum growth hormone levels markedly decreased, clinical symptoms improved, but serum insulin-like growth factor I levels remained unchanged. These observations that serum insulin-like growth factor I levels failed to reflect the decrease of serum growth hormone concentrations after long-acting octreotide treatment suggest that the increased production of insulin-like growth factor I in patients with acromegaly due to McCune-Albright syndrome may involve mechanism(s) other than increased growth hormone levels.

Acromegaly↗
PubMedDate not supplied

[The para-clinic investigation of temporo-mandibular joint changes in patients with acromegaly].

The Acromegaly is an endocrinological disease determined by the hypersecretion of STH in a certain period of the body evolution and it causes the hypertrophy of bones in general and of mandible and cranio-facial bones, determining a disorder due to this development of bones, associated with troubles in the activity of muscles and of the phospho-calcium metabolism. This study was made on a group of 33 acromegaly patients. Their temporo-mandibular joint was investigated by ortopantomography, tomography, computer tomography and scintigraphy. All of these exams shows the changes in temporo-mandibular joint due to the cells hyperactivity determined by the hypersecretion of STH.

Acromegaly↗
PubMedDate not supplied

[A comparative analysis of the brain computer tomography in patients with acromegaly before and after gamma-therapy].

The data given in the paper suggest that X-ray computed tomography is highly effective in evaluating the characteristics of pituitary adenomas in acromegaly and in revealing the changes caused in the pituitary adenoma by gamma-ray teletherapy. The use of brain computed tomography yielded data on the main X-ray criteria to be used in the follow-up of patients undergone radiation therapy for acromegaly.

Acromegaly↗
PubMed2003

Toxic thyroid adenoma and acromegaly: an unusual association.

Hyperthyroidism is seen in 3.5-26% of acromegalic subjects, and can occur through TSH-dependent or independent mechanisms. Thyrotoxicosis as the first presenting illness in acromegaly is particularly uncommon, as described in this patient who had both acromegaly and a toxic thyroid adenoma.

Acromegaly↗
PubMed1992

[External pituitary irradiation therapy for acromegaly].

128 acromegaly patients were followed up for 1-23 years (mean 5.9 +/- 5.0 years) after external pituitary irradiation; among them 104 patients received fractional irradiation with an ultimate total dose of 4000-5000 rad. The remaining patients received a total dose of either < 4000 rad or > 5000 rad. Human growth hormone (hGH) level was measured after an oral load of 100g glucose to evaluate the effect of irradiation. After external pituitary irradiation, the serum level of hGH decreased progressively. The decrease was more rapid in the first three years with a decrement of 35.1% per year. 36.2% of all the patients has been judged as clinically inactive with low serum hGH level of < or = 5 ng/ml. 62.1% of the patients was considered as slightly active with hGH level < or = 10 ng/ml in the 15th year after therapy. The effect of irradiation was not influenced by the age of the patients, the course of acromegaly, the size of sella turcica and operation prior to irradiation. If the total dose of irradiation is lower than 4000 rad, the effect will not be good.

Acromegaly↗
PubMed1992

[The eye and acromegaly: apropos of a case of ptosis].

A 60-year-old woman presents with bilateral ptosis and tearing, predominant on the right and existing since many years. Upper tarsus is much enlarged on the right; lacrymal glands are palpable under the upper lid and seem enlarged as well. CT scan and RMN confirms the hypertrophy of subcutaneous lid tissues, lacrymal glands and ocular muscles. The patient is aware of a progressive change in her physical aspect since years. Medical work-up diagnoses major acromegaly. Discussion about the consequences of acromegaly upon the ocular adnexa.

Acromegaly↗
PubMed1992

[Echocardiographic evaluation of the size and systolic and diastolic function of heart muscle i patients with acromegaly].

In 20 patients with acromegaly, morphology of the heart and its systolic and diastolic function were studied by echocardiography, and growth hormone concentration was examined in the serum. Increased muscle mass of the left ventricle was found and that increase depended on disease duration and the growth hormone serum concentration. An increase was also shown of the left ventricular end-diastolic dimension, and the dimensions of left ventricle posterior wall and intraventricular septum, as well as an increase of end-systolic left ventricular dimension and of the size of the left atrium. Out of systolic function parameters, an increase was shown of stroke volume, cardiac output and cardiac index. In 40% of the studied patients an impairment was shown of left ventricular diastolic function but in a half of them no diseases other than acromegaly were found which could have been its cause.

Acromegaly↗
PubMed1992

Clinical experience of octreotide in the treatment of acromegaly.

To evaluate the efficacy and safety of octreotide (a somatostatin analogue) in the treatment of acromegaly, 10 patients were injected subcutaneously with octreotide, 50 micrograms, thrice daily before each meal for two days, followed by 100 micrograms thrice daily for six months. One case dropped out at the initial stage because of diarrhea, and another quit due to a lack of improvement in headaches after treatment for three months. Eight patients completed the study. The results showed that the circumference of the fourth finger and hand volume significantly decreased after treatment. Laboratory data demonstrated that serum growth hormone (GH) and somatomedin-C levels also decreased significantly. However, in six patients without a history of trans-sphenoidal adenomectomy, the serum GH and somatomedin-C levels returned to normal in only one case who had a serum GH level < 20 mU/L before treatment. In the oral glucose tolerance test, paradoxic elevation of GH subsided after treatment. In the TRH test, paradoxic elevation of GH improved after treatment. In the bromocriptine test, octreotide had a synergistic effect on the suppression of GH. All cases had the side effect of injection pain, especially at the initial stage. An increase in intestinal peristalsis and bowel movement occurred in the first week, but symptoms later subsided. Two out of these eight patients had gallbladder sludge after six months of treatment. In conclusion, octreotide is effective in the treatment of acromegaly; however, it is better used in patients who have serum GH levels < 20 mU/L, or after a trans-sphenoidal adenomectomy, and may be combined with bromocriptine to treat the patient.(ABSTRACT TRUNCATED AT 250 WORDS)

Acromegaly↗
PubMed1992

[Pathological changes in face and skull in acromegaly].

31 patients (mean age 52.7 years) suffering from persistent symptoms of a growth hormone producing pituitary adenoma underwent both clinical and roentgenological examinations. The results of standardized x-ray analysis of the viscero- and neurocranium were compared with those of a group of 25 healthy subjects (mean age 42.1 years): Although several remarkable changes were observed, statistically significant changes of the facial skeleton could be found only in the lower jaw. The main contribution to its elongation was given by the chin prominence and the condyle. The findings in the neurocranium could be divided in symptoms of first and symptoms of second choice. With the help of these parameters, a score was established to facilitate interpretation of early signs of acromegaly in lateral skull radiographs. Two clinical symptoms found in our patient sample have not been mentioned before in literature about acromegaly: the so-called "hanging columella" and marked changes in diameter of the canalis mandibularis.

Acromegaly↗
PubMed2003

Dynamic testing in the diagnosis and follow-up of patients with acromegaly.

Acromegaly is an important area of endocrinology which deserves careful biochemical assessment with growth hormone and IGF-I measurements. Growth hormone suppression during oral glucose tolerance and elevated IGF-I levels form the main diagnostic criteria before treatment has begun. After treatment growth hormone levels during oral glucose tolerance and IGF-I levels are assessed again. A significant proportion (about 30%) are disparate. Thus either having elevated growth hormone levels in the presence of a normal IGF-I or vice versa. Dynamic tests for the diagnosis and monitoring of acromegaly are really not helpful. Assays for growth hormone and IGF-I are changing and absolute levels must be treated with circumspection because of the different assays involved. It is essential for the practicing endocrinologist to know which assays are being used by his or her laboratory for the adequate interpretation of the figures that emanate from it.

Acromegaly↗
PubMed2004

[Acromegaly. Treatment of the causal factor and the oral sequelae].

During the last few years, a 64-years-old man experienced a progressive enlargement of his hands, feet, and tongue and an alteration in the position of his frontal teeth. In a university medical clinic acromegaly was diagnosed, based on external features, serum tests, and an oral glucose tolerance test. A pituitary microadenoma was discovered. The most common oral features of acromegaly are a prognatic mandible, interdental spaces, macroglossy, and everted, swollen lips. In this article the primary treatment and the possible oral sequelae are described.

Acromegaly↗