Faculty Collaboration Database

Gender differences and temporal trends over two decades in acromegaly: a single center study in 112 patients. Endocrine 2020 Feb;67(2):423-432

Date

11/05/2019

Pubmed ID

31677093

DOI

10.1007/s12020-019-02123-4

Scopus ID

2-s2.0-85074734591 (requires institutional sign-in at Scopus site)   13 Citations

Abstract

PURPOSE: To evaluate the impact of gender and year at surgery on clinical presentation and postoperative outcomes in acromegaly.

METHODS: Retrospective review of patients operated between 1994 and 2016 to compare presentation and outcomes in groups defined by gender and year of surgery. Kaplan-Meier survival analyses with a composite endpoint (recurrence, reoperation, and radiation) were used for gender comparison and Youden indices for biochemical remission rates changes during study period.

RESULTS: Primary indications for evaluation were phenotype, neurological symptoms, incidentaloma, hypogonadism, and galactorrhea. At surgery, men (N = 54) were younger (43.6 ± 12.7 years) than women (N = 58, 48.7 ± 12.3, P = 0.04). Male:female ratios before and after age 50 were 1.4 and 0.6 respectively. Men had higher mean IGF-1 levels (874 ± 328 vs 716 ± 296, P < 0.01) and smaller tumors (1.8 ± 1.3 cm vs 2.3 ± 1.5, P = 0.04). Postoperative remission rates were comparable (51% men, 56% women) and inversely associated with cavernous sinus invasion and GH levels. Women had longer mean follow-up (5.2 ± 3.4 years vs 3.6 ± 3.6 men, P = 0.02) and longer endpoint-free survival (P < 0.01). At last follow-up, 89.6% women and 70% men had normal IGF-1 levels (P = 0.03). Postoperative remission rates were higher in patients operated after February 15, 2011 (67.35 vs 43.5% previously, P = 0.01). In late vs early surgery group, physical changes as main indication for screening decreased (54 vs 30%, P < 0.01), while incidentaloma and hypogonadism increased. Median GH levels were lower in late vs early surgery group (P = 0.03).

CONCLUSION: We demonstrate gender-specific characteristics and an evolving spectrum of clinical presentation with implications for earlier diagnosis and personalized management of acromegaly.

Author List

Ioachimescu AG, Handa T, Goswami N, Pappy AL 2nd, Veledar E, Oyesiku NM

Author

Adriana G. Ioachimescu MD, PhD Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Acromegaly
Female
Human Growth Hormone
Humans
Hypogonadism
Insulin-Like Growth Factor I
Male
Middle Aged
Postoperative Period
Retrospective Studies
Sex Characteristics
Treatment Outcome