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Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas
Published on: January 17, 2018
The Mexican Acromegaly Registry: Clinical and Biochemical Characteristics at Diagnosis and Therapeutic Outcomes
Lesly A Portocarrero-Ortiz1, Alma Vergara-Lopez1, Maricela Vidrio-Velazquez1
1Instituto Nacional de Neurología y Neurocirugía (L.A.P.-O., C.V.V.-M.), 14269 Mexico City, Mexico; Centro Medico Nacional 20 de Noviembre Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (A.V.-L.), 03100 Mexico City, Mexico; Hospital Regional 110, Instituto Mexicano del Seguro Social (M.V.-V.), 44716 Guadalajara, Jal, Mexico; Unidad Medica de Alta Especialidad 189 (A.M.U.-D.), 91755 Veracruz, Ver, Mexico; Unidad Medica de Alta Especialidad Manuel Avila Camacho (A.G.-D.), Instituto Mexicano del Seguro Social, 7200 Puebla, Pue, Mexico; Instituto Nacional de Ciencias Medicas y Nutricion (A.-A.R.-A., D.C.-R.), 14080 Mexico City, Mexico; ABC Neurological Center (V.M., J.T., M.M.), 05300 Mexico City, Mexico; Hospital General Zaragoza (A.d.J.R.-H.), Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, 09100 Mexico City, Mexico; and Hospital de Especialidades Centro Medico Nacional S.XXI, Instituto Mexicano del Seguro Social (M.M.), 01120 Mexico City, Mexico.
Context:
Acromegaly is a systemic disorder caused by a GH-secreting pituitary adenoma. As with other rare diseases, acromegaly registries developed in various European countries have provided us with important information.
Objective:
The objective of the study was to analyze the epidemiological, clinical, biochemical, and therapeutic data from the Mexican Acromegaly Registry (MAR).
Setting:
The setting of the study was a nationwide patient registry.
Design And Methodology:
The MAR was created in 2009. It gathers data from 24 participating centers belonging to three different institutions using a specifically designed on-line platform. Only patients diagnosed after 1990 were included in the program.
Results:
A total of 2057 patients (51% female, mean age at diagnosis 41.1 ± 24.5 y) have been registered for an estimated prevalence of 18 cases per 1 million inhabitants. Hypertension, glucose intolerance, diabetes, and dyslipidemia were present in 27%, 18.4%, 30%, and 24% of the patients, respectively. The IGF-1 level at diagnosis and the concomitant presence of hypertension were significantly associated with the development of diabetes. Transsphenoidal surgery was the primary treatment in 72% of the patients. Pharmacological treatment, mostly with somatostatin analogs, was administered primarily and adjunctively in 26% and 54% of the patients, respectively. Treatment choice varied among the three participating institutions, with the predominance of pharmacological therapy in two of them and of radiation therapy in the third. Therapeutic outcomes were similar to those reported in the European registries.
Conclusions:
The MAR is the largest and first non-European registry of the disease. Our findings highlight important within-country differences in treatment choice due to variations in the availability of resources.
