Factors associated with therapeutic response in acromegaly diagnosed in the elderly in Spain
Biagetti, Betina (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Iglesias, Pedro (Hospital Universitario Puerta de Hierro Majadahonda (Madrid))
Villar-Taibo, Rocío (Instituto de Investigación Sanitaria de Santiago (IDIS))
Moure, Maria-Dolores (Instituto de Investigación Sanitaria de Santiago (IDIS))
Paja, Miguel (Hospital de Basurto)
Araujo-Castro, Marta (Hospital Universitario Ramón y Cajal (Madrid))
Ares, Jessica (Instituto de Investigación Sanitaria del Principado de Asturias)
Álvarez-Escolá, Cristina (Hospital Universitario La Paz (Madrid))
Vicente, Almudena (Hospital Universitario de Toledo)
Álvarez Guivernau, Èlia (Universitat Autònoma de Barcelona. Departament de Medicina)
Novoa-Testa, Iria (Complejo Hospitalario Universitario de A Coruña)
Guerrero Perez, Fernando (Hospital Universitari de Bellvitge)
Cámara, Rosa (Hospital Universitari i Politècnic La Fe (València))
Lecumberri, Beatriz (Hospital Universitario La Paz (Madrid))
García Gómez, Carlos (Hospital Universitario Puerta de Hierro Majadahonda (Madrid))
Bernabeu Morón, Ignacio (Instituto de Investigación Sanitaria de Santiago (IDIS))
Manjón, Laura (Instituto de Investigación Sanitaria del Principado de Asturias)
Gaztambide, Sonia (Universidad del País Vasco)
Cordido, Fernando (Complejo Hospitalario Universitario de A Coruña)
Webb, S. M 1952- (Institut d'Investigació Biomèdica Sant Pau)
Menéndez Torre, E. (Instituto de Investigación Sanitaria del Principado de Asturias)
Díez, Juan J. (Instituto de Investigación Sanitaria Puerta de Hierro - Segovia de Arana)
Simó, Rafael (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Puig-Domingo, Manel (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)
Universitat Autònoma de Barcelona

Date:	2022
Abstract:	Context: Some reports suggest that acromegaly in elderly patients has a more benign clinical behavior and could have a better response to first-generation long-acting somatostatin receptor ligands (SRL). However, there is no specific therapeutic protocol for this special subgroup of patients. Objective: This study aimed at identifying predictors of response to SRL in elderly patients. Design: Multicentric retrospective nationwide study of patients diagnosed with acromegaly at or over the age of 65 years. Results: One-hundred and eighteen patients (34 men, 84 women, mean age at diagnosis 71. 7 ± 5. 4 years old) were included. Basal insulin-like growth factor type 1 (IGF-1) above the upper limit of normal (ULN) and growth hormone (GH) levels (mean ± SD) were 2. 7 ± 1. 4 and 11. 0 ± 11. 9 ng/ml, respectively. The mean maximal tumor diameter was 12. 3 ± 6. 4 mm, and up to 68. 6% were macroadenoma. Seventy-two out of 118 patients (61. 0%) underwent surgery as primary treatment. One-third of patients required first-line medical treatment due to a rejection of surgical treatment or non-suitability because of high surgical risk. After first-line surgery, 45/72 (63. 9%) were in disease remission, and 16/34 (46. 7%) of those treated with SRL had controlled disease. Patients with basal GH at diagnosis ≤6 ng/ml had lower IGF-1 levels and had smaller tumors, and more patients in this group reached control with SRL (72. 7% vs. 33. 3%; p < 0. 04) [OR: 21. 3, IC: 95% (2. 4-91. 1)], while male patients had a worse response [OR: 0. 09, IC 95% (0. 01-0. 75)]. The predictive model curve obtained for SRL response showed an AUC of 0. 82 CI (0. 71-0. 94). Conclusions: The most frequent phenotype in newly diagnosed acromegaly in the elderly includes small adenomas and moderately high IGF-1 levels. GH at diagnosis ≤6 ng/ml and female gender, but not age per se, were associated with a greater chance of response to SRL.
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Language:	Anglès
Document:	Article ; recerca ; Versió publicada
Subject:	Acromegaly ; Elderly ; Growth hormone ; IGF-1 (insulin-like growth factor 1) ; Somatostatin analog ; Surgery ; Spain
Published in:	Frontiers in endocrinology, Vol. 13 (September 2022) , p. 984877, ISSN 1664-2392

DOI: 10.3389/fendo.2022.984877
PMID: 36187107

10 p, 635.4 KB

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