Age-dependent differences in acromegaly at diagnosis
B. Firlatana (Dr), SN. Sendur*a (Dr), S. Oguza (Dr), S. Dagdelena (Dr), T. Erbasa (Dr)
a Hacettepe University, Ankara, TURKEY
Introduction: Age at diagnosis (AaD) and disease duration are among the factors affecting the disease outcome in acromegaly. We identified the distinctive features of patients with acromegaly according to AaD.
Methods: 384 patients with acromegaly were included. Patients were divided into three groups based on the AaD (group 1, 20-40; group 2, 41-60; group 3, >60 years). Data regarding the demographic and clinical features, pre-operative hormone levels, radiological and pathological characteristics of adenoma, treatment modalities, and comorbidities were retrieved.
Results: Groups consisted of 194 (88F/106M), 167 (84F/83M), and 23 (13F/10M) patients, respectively. Gender distribution was similar. Pre-operative GH and prolactin levels were significantly higher in group 1 compared to patients in groups 2 and 3 (p<0.001 and p=0.002, respectively). Pre-operative IGF-1 levels were lowest in group 3. The maximum tumor diameter was highest in group 1 patients [20 mm (14-27) vs. 13 mm (9-20) vs. 10.5 mm (9-15), p<0.001]. Macroadenoma was detected in 139 (71.7%) of group 1 patients, 92 (55.1%) of group 2 patients, and 13 (56.5%) of group 3 patients (p<0.001). Suprasellar extension and cavernous sinus invasion were more common in group 1 (p=0.005 and p=0.003, respectively). Ki-67 index was > 3% in 7.2% and 2.4% of patients in groups 1 and 2, respectively. In contrast, none of the patients in group 3 showed Ki-67 index > 2%. There was a significant difference between groups regarding the use of somatostatin receptor ligands (68.6% vs. 55.1% vs. 47.8%, p=0.011) and dopamine agonist (20.6% vs. 10.8% vs. 0%, p=0.004). The distribution of patients who received radiotherapy was also significantly different between groups (p=0.002). Hypopituitarism was present in 53 (27.3%) and 32 (19.2%) patients in groups 1 and 2, respectively whereas none of the patients in group 3 had hypopituitarism (p=0.006). When patient groups were evaluated according to comorbidities; hypertension, diabetes mellitus, hyperlipidemia, and coronary artery disease were found to be less common in group 1 patients.
Conclusion: Younger patients with acromegaly had higher hormone levels, and larger and more aggressive tumors. Clinicians should be aware of age-related differences in patients with acromegaly.
The author has declared no conflict of interest.