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Title: Factors associated with therapeutic response in acromegaly diagnosed in the elderly in Spain
Author: Biagetti, Betina
Iglesias, Pedro
Villar Taibo, Rocío
Moure, María Dolores
Paja, Miguel
Araujo Castro, Marta
Ares, Jessica
Álvarez Escolá, Cristina
Vicente, Almudena
Álvarez Guivernau, Èlia
Novoa Testa, Iria
Guerrero Perez, Fernando
Cámara, Rosa
Lecumberri, Beatriz
García Gómez, Carlos
Bernabéu, Ignacio
Manjón, Laura
Gaztambide, Sonia
Cordido, Fernando
Webb, Susan M.
Menéndez Torre, Edelmiro Luis
Díez, Juan J.
Simó Canonge, Rafael
Puig Domingo, Manuel
Keywords: Persones grans
Older people
Issue Date: 16-Sep-2022
Publisher: Frontiers Media SA
Abstract: ContextSome reports suggest that acromegaly in elderly patients has a more benign clinical behavior and could have a better response to first-generation long-acting somatostatin receptor ligands (SRL). However, there is no specific therapeutic protocol for this special subgroup of patients. ObjectiveThis study aimed at identifying predictors of response to SRL in elderly patients. DesignMulticentric retrospective nationwide study of patients diagnosed with acromegaly at or over the age of 65 years. ResultsOne-hundred and eighteen patients (34 men, 84 women, mean age at diagnosis 71.7 +/- 5.4 years old) were included. Basal insulin-like growth factor type 1 (IGF-1) above the upper limit of normal (ULN) and growth hormone (GH) levels (mean +/- SD) were 2.7 +/- 1.4 and 11.0 +/- 11.9 ng/ml, respectively. The mean maximal tumor diameter was 12.3 +/- 6.4 mm, and up to 68.6% were macroadenoma. Seventy-two out of 118 patients (61.0%) underwent surgery as primary treatment. One-third of patients required first-line medical treatment due to a rejection of surgical treatment or non-suitability because of high surgical risk. After first-line surgery, 45/72 (63.9%) were in disease remission, and 16/34 (46.7%) of those treated with SRL had controlled disease. Patients with basal GH at diagnosis <= 6 ng/ml had lower IGF-1 levels and had smaller tumors, and more patients in this group reached control with SRL (72.7% vs. 33.3%; p < 0.04) [OR: 21.3, IC: 95% (2.4-91.1)], while male patients had a worse response [OR: 0.09, IC 95% (0.01-0.75)]. The predictive model curve obtained for SRL response showed an AUC of 0.82 CI (0.71-0.94). ConclusionsThe most frequent phenotype in newly diagnosed acromegaly in the elderly includes small adenomas and moderately high IGF-1 levels. GH at diagnosis <= 6 ng/ml and female gender, but not age per se, were associated with a greater chance of response to SRL.
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It is part of: Frontiers in Endocrinology, 2022, vol. 13
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ISSN: 1664-2392
Appears in Collections:Articles publicats en revistes (Institut d'lnvestigació Biomèdica de Bellvitge (IDIBELL))

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