Clinical presentation and management of acromegaly in elderly patients
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ORIGINAL ARTICLE
Clinical presentation and management of acromegaly in elderly patients Filippo Ceccato 1,2 & Mattia Barbot 1 & Laura Lizzul 1 & Angela Cuccarollo 1 & Elisa Selmin 1 & Isabella Merante Boschin 1,3 & Andrea Daniele 1 & Alois Saller 4 & Gianluca Occhi 5 & Daniela Regazzo 1 & Carla Scaroni 1 Received: 6 March 2020 / Accepted: 30 July 2020 # The Author(s) 2020
Abstract Background and aim Acromegaly is a rare disease with a peak of incidence in early adulthood. However, enhanced awareness of this disease, combined with wide availability of magnetic resonance imaging (MRI), has increased the diagnosis of forms with mild presentation, especially in elderly patients. Moreover, due to increased life expectancy and proactive individualized treatment, patients with early-onset acromegaly are today aging. The aim of our study was to describe our cohort of elderly patients with acromegaly. Materials and methods This is a cross-sectional retrospective study of 96 outpatients. Clinical, endocrine, treatment, and followup data were collected using the electronic database of the University Hospital of Padova, Italy. Results We diagnosed acromegaly in 13 patients, aged ≥65 years, presenting with relatively small adenomas and low IGF-1 secretion. Among them, 11 patients were initially treated with medical therapy and half normalized hormonal levels after 6 months without undergoing neurosurgery (TNS). Remission was achieved after TNS in three out of four patients (primary TNS in two); ten patients presented controlled acromegaly at the last visit. Acromegaly-related comorbidities (colon polyps, thyroid cancer, adrenal incidentaloma, hypertension, and bone disease) were more prevalent in patients who had an early diagnosis (31 patients, characterized by a longer follow-up of 24 years) than in those diagnosed aged ≥65 years (5 years of follow-up). Conclusions Elderly acromegalic patients are not uncommon. Primary medical therapy is a reasonable option and is effectively used, while the rate of surgical success is not reduced. A careful cost-benefit balance is suggested. Disease-specific comorbidities are more prevalent in acromegalic patients with a longer follow-up rather than in those diagnosed aged ≥65 years. Keywords Acromegaly . Diagnosis . Medical treatment . Aging
Introduction
* Filippo Ceccato [email protected] 1
Endocrinology Unit, Department of Medicine DIMED, University Hospital of Padova, Via Ospedale Civile, 105-35128 Padova, Italy
2
Department of Neurosciences DNS, University of Padova, Padova, Italy
3
Department of Surgical, Oncological and Gastroenterological Sciences DiSCOG, University of Padova, Padova, Italy
4
Internal Medicine, Department of Medicine DIMED, University Hospital of Padova, Padova, Italy
5
Department of Biology, University of Padova, Padova, Italy
Acromegaly is a rare disease, usually due to a pituitary adenoma, characterized by increased GH and IGF-1 levels.[1, 2] It is usually diagnosed in young adults (between 35 and 45 years), and only a few cases are reported a
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