Factors associated with therapeutic response in acromegaly diagnosed in the elderly in Spain
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.Objective...
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Frontiers Media S.A.
2022-09-01
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| Series: | Frontiers in Endocrinology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fendo.2022.984877/full |
| _version_ | 1798033742129790976 |
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| author | Betina Biagetti Pedro Iglesias Rocío Villar-Taibo María-Dolores Moure María-Dolores Moure Miguel Paja Marta Araujo-Castro Jessica Ares Jessica Ares Cristina Álvarez-Escola Almudena Vicente Èlia Álvarez Guivernau Èlia Álvarez Guivernau Iria Novoa-Testa Fernando Guerrero Perez Rosa Cámara Beatriz Lecumberri Carlos García Gómez Ignacio Bernabéu Laura Manjón Laura Manjón Sonia Gaztambide Sonia Gaztambide Fernando Cordido Susan M. Webb Susan M. Webb Edelmiro Luis Menéndez-Torre Edelmiro Luis Menéndez-Torre Juan J. Díez Juan J. Díez Rafael Simó Manel Puig-Domingo |
| author_facet | Betina Biagetti Pedro Iglesias Rocío Villar-Taibo María-Dolores Moure María-Dolores Moure Miguel Paja Marta Araujo-Castro Jessica Ares Jessica Ares Cristina Álvarez-Escola Almudena Vicente Èlia Álvarez Guivernau Èlia Álvarez Guivernau Iria Novoa-Testa Fernando Guerrero Perez Rosa Cámara Beatriz Lecumberri Carlos García Gómez Ignacio Bernabéu Laura Manjón Laura Manjón Sonia Gaztambide Sonia Gaztambide Fernando Cordido Susan M. Webb Susan M. Webb Edelmiro Luis Menéndez-Torre Edelmiro Luis Menéndez-Torre Juan J. Díez Juan J. Díez Rafael Simó Manel Puig-Domingo |
| author_sort | Betina Biagetti |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-04-11T20:33:53Z |
| format | Article |
| id | doaj.art-fb78602a2805401181897303e82d5a69 |
| institution | Directory Open Access Journal |
| issn | 1664-2392 |
| language | English |
| last_indexed | 2024-04-11T20:33:53Z |
| publishDate | 2022-09-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Endocrinology |
| spelling | doaj.art-fb78602a2805401181897303e82d5a692022-12-22T04:04:25ZengFrontiers Media S.A.Frontiers in Endocrinology1664-23922022-09-011310.3389/fendo.2022.984877984877Factors associated with therapeutic response in acromegaly diagnosed in the elderly in SpainBetina Biagetti0Pedro Iglesias1Rocío Villar-Taibo2María-Dolores Moure3María-Dolores Moure4Miguel Paja5Marta Araujo-Castro6Jessica Ares7Jessica Ares8Cristina Álvarez-Escola9Almudena Vicente10Èlia Álvarez Guivernau11Èlia Álvarez Guivernau12Iria Novoa-Testa13Fernando Guerrero Perez14Rosa Cámara15Beatriz Lecumberri16Carlos García Gómez17Ignacio Bernabéu18Laura Manjón19Laura Manjón20Sonia Gaztambide21Sonia Gaztambide22Fernando Cordido23Susan M. Webb24Susan M. Webb25Edelmiro Luis Menéndez-Torre26Edelmiro Luis Menéndez-Torre27Juan J. Díez28Juan J. Díez29Rafael Simó30Manel Puig-Domingo31Endocrinology Department, Diabetes and Metabolism Research Unit, Vall d’Hebron University Hospital and Vall d’Hebron Research Institute (VHIR), Universidad Autónoma de Barcelona, Barcelona, SpainDepartment of Endocrinology, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, SpainEndocrinology Department, University Hospital of Santiago de Compostela, Neoplasia and Differentiation of Endocrine Cells Group, Instituto de Investigación Sanitaria-IDIS (Health Research Institute), Santiago de Compostela, SpainEndocrinology Department, Cruces University Hospital, Biocruces Bizkaia, Endo-European Reference Networks (ERN), Barakaldo, SpainNeoplasia and Differentiation of Endocrine Cells Group, Instituto de Investigación Sanitaria-IDIS (Health Research Institute), Santiago de Compostela, SpainDepartment of Endocrinology, Hospital Universitario Basurto, Bilbao, SpainDepartment of Endocrinology and Nutrition, Hospital Universitario Ramón y Cajal, Madrid, SpainDepartment of Endocrinology and Nutrition, Hospital Universitario Central de Asturias, Asturias, SpainInstituto de Investigación Sanitaria del Principado de Asturias (ISPA), Centro de Investigación Biomédica en Red Enfermedades Raras (CIBERER), Universidad de Oviedo, Oviedo, Spain0Department of Endocrinology, Hospital Universitario La Paz, Madrid, Spain1Department of Endocrinology and Nutrition, Hospital Universitario de Toledo, Toledo, Spain2Department of Endocrinology, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Hospital Sant Pau, Institut d’Investigacions Biomèdiques (IIB) SPau, Barcelona, Spain3Department of Medicine, Universitat Autónoma de Barcelona, Barcelona, Spain4Endocrinology and Nutrition Department, A Coruña University Hospital and A Coruña University, A Coruña, Spain5Department of Endocrinology, Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain6Endocrinology and Nutrition Service, La Fe University Hospital, Valencia, Spain0Department of Endocrinology, Hospital Universitario La Paz, Madrid, SpainDepartment of Endocrinology, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, SpainEndocrinology Department, University Hospital of Santiago de Compostela, Neoplasia and Differentiation of Endocrine Cells Group, Instituto de Investigación Sanitaria-IDIS (Health Research Institute), Santiago de Compostela, SpainDepartment of Endocrinology and Nutrition, Hospital Universitario Central de Asturias, Asturias, SpainInstituto de Investigación Sanitaria del Principado de Asturias (ISPA), Centro de Investigación Biomédica en Red Enfermedades Raras (CIBERER), Universidad de Oviedo, Oviedo, SpainEndocrinology Department, Cruces University Hospital, Biocruces Bizkaia, Endo-European Reference Networks (ERN), Barakaldo, Spain7Health Research Institute, Universidad País Vasco - Euskal Herriko Unibertsitatea (UPV-EHU), Centro de Investigación Biomédica en Red Enfermedades Raras (CIBERER), Centro de Investigación Biomédica en Red Diabetes y Enfermedades Metabólicas (CIBERDEM), Barakaldo, Spain4Endocrinology and Nutrition Department, A Coruña University Hospital and A Coruña University, A Coruña, Spain2Department of Endocrinology, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Hospital Sant Pau, Institut d’Investigacions Biomèdiques (IIB) SPau, Barcelona, Spain3Department of Medicine, Universitat Autónoma de Barcelona, Barcelona, SpainDepartment of Endocrinology and Nutrition, Hospital Universitario Central de Asturias, Asturias, SpainInstituto de Investigación Sanitaria del Principado de Asturias (ISPA), Centro de Investigación Biomédica en Red Enfermedades Raras (CIBERER), Universidad de Oviedo, Oviedo, SpainDepartment of Endocrinology, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain8Department of Medicine, Instituto de Investigación Sanitaria Puerta de Hierro Segovia de Arana, Universidad Autónoma de Madrid, Majadahonda, SpainEndocrinology Department, Diabetes and Metabolism Research Unit, Vall d’Hebron University Hospital and Vall d’Hebron Research Institute (VHIR), Universidad Autónoma de Barcelona, Barcelona, Spain9Endocrinology and Nutrition Service, Germans Trias Hospital and Research Institute, Autonomous University of Barcelona, Badalona, SpainContextSome 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.https://www.frontiersin.org/articles/10.3389/fendo.2022.984877/fullacromegalyelderlygrowth hormoneIGF-1 (insulin-like growth factor 1)somatostatin analogsurgery |
| spellingShingle | Betina Biagetti Pedro Iglesias Rocío Villar-Taibo María-Dolores Moure María-Dolores Moure Miguel Paja Marta Araujo-Castro Jessica Ares Jessica Ares Cristina Álvarez-Escola Almudena Vicente Èlia Álvarez Guivernau Èlia Álvarez Guivernau Iria Novoa-Testa Fernando Guerrero Perez Rosa Cámara Beatriz Lecumberri Carlos García Gómez Ignacio Bernabéu Laura Manjón Laura Manjón Sonia Gaztambide Sonia Gaztambide Fernando Cordido Susan M. Webb Susan M. Webb Edelmiro Luis Menéndez-Torre Edelmiro Luis Menéndez-Torre Juan J. Díez Juan J. Díez Rafael Simó Manel Puig-Domingo Factors associated with therapeutic response in acromegaly diagnosed in the elderly in Spain Frontiers in Endocrinology acromegaly elderly growth hormone IGF-1 (insulin-like growth factor 1) somatostatin analog surgery |
| title | Factors associated with therapeutic response in acromegaly diagnosed in the elderly in Spain |
| title_full | Factors associated with therapeutic response in acromegaly diagnosed in the elderly in Spain |
| title_fullStr | Factors associated with therapeutic response in acromegaly diagnosed in the elderly in Spain |
| title_full_unstemmed | Factors associated with therapeutic response in acromegaly diagnosed in the elderly in Spain |
| title_short | Factors associated with therapeutic response in acromegaly diagnosed in the elderly in Spain |
| title_sort | factors associated with therapeutic response in acromegaly diagnosed in the elderly in spain |
| topic | acromegaly elderly growth hormone IGF-1 (insulin-like growth factor 1) somatostatin analog surgery |
| url | https://www.frontiersin.org/articles/10.3389/fendo.2022.984877/full |
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