Acromegaly in the developing world--a 20-year teaching hospital experience

Area of Science:

• Endocrinology
• Neurosurgery

Background:

• Acromegaly, a condition caused by excess growth hormone (GH), poses significant health risks.
• Effective long-term management strategies for acromegaly are essential.

Purpose of the Study:

• To evaluate the long-term outcomes of surgery and radiotherapy for acromegaly.
• To assess cure rates, disease control, and complications in patients treated at Groote Schuur Hospital.

Main Methods:

• A retrospective analysis of 72 acromegaly patients treated by a single pituitary surgeon and/or radiotherapy.
• Inclusion criteria based on modern definitions of cure, with a mean follow-up of 8.3 years for surgery and 8.7 years for radiotherapy.
• Assessment of pretreatment GH levels, tumor characteristics (macroadenoma/microadenoma), and post-treatment outcomes including hypopituitarism.

Main Results:

• Post-surgery, 21% of patients achieved cure, 40% were controlled, and 40% developed hypopituitarism.
• Radiotherapy resulted in higher cure rates (43%) but also higher rates of hypopituitarism (78%).
• Vascular disease was the most common cause of death (37% of traced patients), linked to late presentation, large tumors, and high GH levels.

Conclusions:

• Surgical outcomes for acromegaly were suboptimal, potentially due to late diagnosis and advanced tumor presentation in a developing world context.
• Radiotherapy offered higher cure rates but increased the risk of hypopituitarism.
• Early diagnosis of non-invasive tumors is critical for improving acromegaly treatment efficacy and reducing patient mortality.