Socioeconomic factors associated with post-operative biochemical remission in acromegaly

Growth Hormone (GH)-secreting pituitary neuroendocrine tumors (PitNETs) are the leading cause of acromegaly, yet predictors of postoperative biochemical remission remain incompletely defined. This study evaluated the association between socioeconomic status (SES) and the likelihood of biochemical remission after transsphenoidal resection.

The authors retrospectively reviewed 184 patients who underwent transsphenoidal resection for GH-secreting PitNETs at a single institution. Demographic, socioeconomic, and clinical variables included sex, race, ethnicity, language proficiency, insurance, primary care provider status, zip code-based median household income, and preoperative IGF-1 levels expressed as a multiple of the upper limit of normal (mULN). Biochemical remission was defined as postoperative normalization of age- and sex-adjusted insulin-like growth factor 1 together with a postoperative random GH level < 1.0 ng/mL or a GH level ≤ 0.4 ng/mL following oral glucose tolerance testing within 6 months after surgery, without postoperative medical therapy, radiotherapy, or repeat surgery. Associations were evaluated using univariable comparisons and multivariable logistic regression.

Of 184 patients, 111 met the combined IGF-1 and GH criteria for postoperative biochemical remission. Patients who achieved remission lived in zip codes with higher median household income than non-remitters ($107,000 vs. $93,000; p = 0.015). In multivariable logistic regression, the lowest income tertile was associated with lower odds of remission compared with the high-income tertile (OR 0.29, 95% CI 0.10-0.83, p = 0.021).

Zip code-based median household income was associated with a higher likelihood of biochemical remission after surgery for acromegaly, suggesting that SES may represent an important determinant of postoperative endocrine outcomes.