Clinical, hormonal, and treatment outcomes in 247 patients with acromegaly: a single tertiary center experience

This study aimed to evaluate the demographic, clinical, and hormonal characteristics; comorbidities; surgical pathology; treatment modalities; and long-term clinical outcomes of patients diagnosed with and managed for acromegaly at our tertiary referral center over a 15-year period.

Between 2010 and 2024, 247 patients with acromegaly were evaluated. Diagnosis and biochemical remission were determined according to the 2024 Acromegaly Consensus Criteria.

The median follow-up duration was 8 years (IQR: 3-14). At the time of diagnosis, the most frequent pituitary hormone deficiency was secondary adrenal insufficiency, present in 17.8% of patients. The most common comorbidities were hypertension (HT, 42.1%) and diabetes mellitus (DM, 30.8%). At the time of diagnosis, macroadenomas were present in 153 of 193 patients (79.3%), and, according to the Knosp classification, 28.6% of tumors were grade 4. A total of 218 patients underwent surgical intervention; 86 (39.4%) achieved postoperative cure without the need for adjuvant medical therapy or radiotherapy. Postoperatively, one or more anterior pituitary hormone deficiencies were found in 34 patients (22.8%), with central hypothyroidism being the most common (52.9%). Patients who achieved biochemical remission were significantly older (p = 0.003), had a higher prevalence of HT and DM (both p < 0.05), and were more likely to exhibit positive growth hormone (GH) immunostaining (p = 0.017). In contrast, those who did not achieve remission were more likely to have higher Knosp grades (3-4) (p = 0.002).

In this study, a favorable prognosis was associated with older age at diagnosis, lower baseline GH levels, positive GH immunostaining, smaller tumor size, and lower Knosp grade, underscoring the prognostic value of both biochemical and anatomical parameters. Further studies are warranted to refine prognostic markers and establish standardized treatment algorithms to improve long-term outcomes in acromegaly.