NEWS IN ACROMEGALY

Abstract

Recent updates on the epidemiology, diagnosis, complications and therapy in acromegaly have been published in the 1^st 2017 issue of Pituitary journal. A review of 12 epidemiological studies published since 2004 shows that the prevalence of acromegaly ranges 2.8 - 13.7 cases per 100,000 people and the annual incidence rates range 0.2 - 1.1 cases/100,000 people. The median age at diagnosis ranges between 40.5 and 47 years. At the time of diagnosis, over 2/3 of the patients have macroadenomas. Acromegalic osteopathy is characterized by increase in bone turnover, alterations in bone microarchitecture and high risk of vertebral fractures, which occur in about 1/3 of acromegaly patients. Fractures may occur even in the presence of normal bone mineral density (BMD), in close relationship with male gender, hypogonadism, and active acromegaly. Following treatment for acromegaly in 48 patients, the mean trabecular bone score decreased by 3.0 (±7.0) %, whereas BMD at the lumbar spine increased by 3.2 (±4.9) % (both P<0.01). Alterations in trabecular bone architecture may explain the persistent fracture risk despite the increase in BMD after disease control. Stereotactic radiotherapy in acromegaly after surgery and/or during medical therapy provide tumor control in 93-100% of patients at 5-10 years and endocrinological remission in 40-60% of patients at 5 years, with a hypopituitarism rate of 10-50% at 5 years. Hypofractionated radiosurgery is an optimal option for tumors located near the optic structures, due to its lower toxicity for the optic nerves compared to single-dose radiosurgery. A dose-response model for visual pathway tolerance to SRS has been recently published.

Keywords: acromegaly; epidemiology; fracture risk; radiosurgery; stereotactic radiotherapy.