Epidemiology, treatment trends and outcomes of acromegaly

Abstract

Dear Editor: Acromegaly is a rare, chronic disorder, with classical clinical features caused by excess growth hormone (GH) production and consequent raised levels of insulin growth factor-1 (IGF-1). In more than 90% of cases, this is due to GH hyper secretion from a pituitary somatotroph adenoma. The estimated incidence is 3–4 per million and prevalence varies between 33.7 and 70 per million. Acromegaly is diagnosed by nadir GH levels > 1 μg/L during an oral glucose tolerance test (OGTT) together with an IGF-I above the upper limit of normal matched for age and gender. Acromegaly is associated with significant morbidity and mortality which is primarily attributable to cardiovascular disease.

The latest consensus guidelines define controlled disease as 1) a normal IGF-1 level adjusted for age and 2) a GH level less than 1.0 μg/L from a random GH measurement or a nadir GH of 0.4 μg/L after an OGTT. The last two decades have seen major advances in the surgical and pharmacological treatment. Transsphenoidal surgery (TSS) is widely accepted as the initial treatment of choice. However, post-operative remission rates vary widely. [excerpt]