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NEWS IN ACROMEGALY.

M L Gheorghiu1

  • 1"Carol Davila" University of Medicine and Pharmacy, "C.I. Parhon" National Institute of Endocrinology, Bucharest, Romania.

Acta Endocrinologica (Bucharest, Romania : 2005)
|June 1, 2019
PubMed
Summary

Acromegaly affects 2.8-13.7 per 100,000 people, often diagnosed around age 40 with macroadenomas. Treatment improves bone density but persistent fracture risk remains due to microarchitecture changes.

Area of Science:

  • Endocrinology
  • Oncology
  • Orthopedics

Background:

  • Acromegaly prevalence ranges from 2.8 to 13.7 cases per 100,000 people, with a median diagnosis age of 40.5-47 years.
  • Macroadenomas are present in over two-thirds of patients at diagnosis.
  • Acromegalic osteopathy involves increased bone turnover and altered microarchitecture, leading to a high risk of vertebral fractures.

Discussion:

  • Fractures in acromegaly patients can occur even with normal bone mineral density (BMD), correlating with male gender, hypogonadism, and active disease.
  • Treatment for acromegaly led to a decrease in trabecular bone score and an increase in lumbar spine BMD, suggesting persistent fracture risk despite disease control.
  • Stereotactic radiotherapy offers high tumor control rates (93-100%) and significant endocrinological remission (40-60%) in acromegaly patients, with a notable rate of hypopituitarism (10-50%).
Keywords:
acromegalyepidemiologyfracture riskradiosurgerystereotactic radiotherapy

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Key Insights:

  • Acromegaly epidemiology reveals a significant disease burden and diagnostic challenges.
  • Altered bone microarchitecture contributes to persistent fracture risk post-treatment.
  • Radiotherapy, particularly hypofractionated radiosurgery, is effective for tumor control and offers a favorable toxicity profile for optic structures.

Outlook:

  • Further research into the mechanisms underlying persistent fracture risk in acromegaly is warranted.
  • Optimizing radiotherapy techniques and understanding visual pathway tolerance are crucial for managing patients with pituitary tumors.
  • Long-term monitoring for hypopituitarism and skeletal complications is essential for acromegaly survivors.