Abstrakt

Acromegaly: casuistry of therapeutic success clinical and surgical

Beatriz Dal Santo Francisco Bonamichi, Rafael Bonamichi dos Santos, Nilza Maria Scalissi, Americo Leite dos Santos, Jos

Background: Acromegaly is a rare disease characterized as a disfiguring and progressive disorder caused by prolonged exposure of high levels of growth hormone (GH) and insulin-like growth factor 1 (IGF-1).

Objective: To evaluate treatment management and follow-up with patients who have acromegaly.

Method: Cross-sectional observational study comprising 37 patients with acromegaly. The criterion used to control the disease was the dosage of GH and IGF-1. According to current guidelines defined in this study: 1) controlled disease (CD): basal GH<1.0 ng/ml or GH nadir in oral glucose tolerance test (OGTT)<0.4 ng/ml and IGF-1 standard; 2) uncontrolled (DNC): Basal GH>1.0 ng/ml or nadir in OGTT>0.4 ng/ml IGF-1 and higher; 3) inadequately controlled (DIC): Normal GH and IGF-1 higher or high GH and IGF-1 standard.

Results: 37 patients, mean age 49 ± 10.7 years. The mean baseline GH at diagnosis was 15.3 ng/ ml, with a mean reduction to 4.5 ng/ml in the treatment clinical, to 5.28 ng/ml in clinical and surgical, to 21.18 ng/ml only surgical. The average IGF-1 was 176.5. The biochemical remission rate was 90.6%, being that 62.5% with CD and 28.1% with DIC. Only 9.4% developed with DNC. The tumor had a median size of 1.9 cm in DC. As early as DNC, the median was 3.1 cm. Patients with DC that used Sandostatin were 80%, being that 55% cabergoline associated, 10% only cabergoline, 10% had no surgery. 30% suspended medications due to successful therapeutics.

Conclusion: Our study demonstrated that acromegaly treatment is most effective with surgical and pharmacological combination. It is importantly, however, to reveal that the surgical and pharmacological treatment was successful and medications may suspend later in certain situations.