Keywords
Gender
Age groups
Surgery
Medical therapy
Radiation
How to Cite
Abstract
Context: Acromegaly is a rare disease characterized by excessive growth of bones and soft tissues due to hypersecretion of the growth hormone (GH), usually associated with pituitary tumors. Timely diagnosis and treatment are essential to reduce chronic complications.
Objective: To determine if there are clinical differences and differences in the treatment response according to age and gender in patients with acromegaly in Colombia.
Methods: Observational, analytical, multicenter, retrospective cohort study based on a national registry of patients with acromegaly in Colombia.
Results: A total of 201 patients were included (of whom 60% were women and 75% were under 60 years old). The average weight was 75.1 kg ± 12.9 and the height was 1.63 m ± 0.08, with men and those under 60 years old tending to be taller. The average time of evolution of the disease until diagnosis was 6.9 ± 4.4 years, however, older adults had a longer time of 8.6 ± 5.7 years, with no differences with respect to gender. The most common type of tumor was macroadenoma in 78% of cases. In addition to the classic symptoms of the disease, decreased libido was found more frequently in men, and depression was predominant in those over 60 years old. Arterial hypertension, colonic and hepatobiliary pathology were more common in women. Cardiomyopathy, hypertension and bone pathology (osteoporosis and osteopenia) were more frequent among people over 60 years old. Surgical intervention, combined with medical management, was the preferred treatment approach for individuals aged 18 to 60 and was associated with improved clinical outcomes.
Conclusion: The combined treatment of surgery and medical management was associated with better clinical control of acromegaly, with no significant differences in disease control by gender or age group.
References
de Herder WW. The History of Acromegaly. Neuroendocrinol. 2016;103(1):7–17. https://doi.org/10.1159/000371808
Kasuki L, Antunes X, Lamback EB, Gadelha MR. Acromegaly: Update on Management and Long-Term Morbidities. Endocrinol Metab Clin North Am. 2020;49(3):475–86. https://doi.org/10.1016/j.ecl.2020.05.007
Broder, M. S., Chang, E., Cherepanov, D., Neary, M. P., & Ludlam, W. H. (2016). INCIDENCE AND PREVALENCE OF ACROMEGALY IN THE UNITED STATES: A CLAIMS-BASED ANALYSIS. Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists, 22(11), 1327-1335. https://doi.org/10.4158/EP161397.OR
Chin SO. Epidemiology of Functioning Pituitary Adenomas. Endocrinol Metab. 2020;35(2):237–42. https://doi.org/10.3803/EnM.2020.35.2.237
Daly AF, Rixhon M, Adam C, Dempegioti A, Tichomirowa MA, Beckers A. High prevalence of pituitary adenomas: a cross-sectional study in the province of Liege, Belgium. J Clin Endocrinol Metab. 2006;91(12):4769–75. https://doi.org/10.1210/jc.2006-1668
Castellanos-Bueno R, Abreu-Lomba A, Buitrago-Gómez N, Patiño-Arboleda M, Pantoja-Guerrero D, Valenzuela-Rincón A, et al. Clinical and epidemiological characteristics, morbidity and treatment based on the registry of acromegalic patients in Colombia: RAPACO. Growth Horm IGF Res. 2021;60–61:101425. https://doi.org/10.1016/j.ghir.2021.101425
Knappe UJ, Petroff D, Quinkler M, Schmid SM, Schöfl C, Schopohl J, et al. Fractionated radiotherapy and radiosurgery in acromegaly: analysis of 352 patients from the German Acromegaly Registry. Eur J Endocrinol. 2020;182(3):275–84. https://doi.org/10.1530/EJE-19-0784
Sesmilo G, Gaztambide S, Venegas E, Picó A, Del Pozo C, Blanco C, et al. Changes in acromegaly treatment over four decades in Spain: analysis of the Spanish Acromegaly Registry (REA). Pituitary. 2013;16:115–21. https://doi.org/10.1007/s11102-012-0384-x
Maione L, Chanson P. National acromegaly registries. Best Pract Res Clin Endocrinol Metab. 2019;33(2):101264. https://doi.org/10.1016/j.beem.2019.02.001
Portocarrero-Ortiz LA, Vergara-Lopez A, Vidrio-Velazquez M, Uribe-Diaz AM, García-Dominguez A, Reza-Albarrán AA, et al. The Mexican Acromegaly Registry: Clinical and Biochemical Characteristics at Diagnosis and Therapeutic Outcomes. J Clin Endocrinol Metab. 2016;101(11):3997–4004. https://doi.org/10.1210/jc.2016-1937
Dal J, Feldt-Rasmussen U, Andersen M, Kristensen LØ, Laurberg P, Pedersen L, et al. Acromegaly incidence, prevalence, complications and long-term prognosis: a nationwide cohort study. Eur J Endocrinol. 2016;175(3):181–90. https://doi.org/10.1530/EJE-16-0117
Araujo-Castro M, Biagetti B, Menéndez Torre E, Novoa-Testa I, Cordido F, Pascual Corrales E, et al. Differences Between GH-and PRL-Cosecreting and GH-Secreting Pituitary Adenomas: a Series of 604 Cases. J Clin Endocrinol Metab . 2024:109(12); e2178–e2187. https://doi.org/10.1210/clinem/dgae126
Fekete C, Lechan RM. Central regulation of hypothalamic-pituitary-thyroid axis under physiological and pathophysiological conditions. Endocr Rev. 2014;35(2):159–94. https://doi.org/10.1210/er.2013-1087
Cuevas-Ramos D, Carmichael JD, Cooper O, Bonert VS, Gertych A, Mamelak AN, et al. A structural and functional acromegaly classification. J Clin Endocrinol Metab. 2015;100(1):122–31. https://doi.org/10.1210/jc.2014-2468
Biagetti B, Iglesias P, Villar-Taibo R, Moure MD, Paja M, Araujo-Castro M, et al. Mortality in Acromegaly Diagnosed in Older Individuals in Spain Is Higher in Women Compared to the General Spanish Population. J Clin Endocrinol Metab. 2023:108(9), 2193–2202. https://doi.org/10.1210/clinem/dgad141
Vilar L, Vilar CF, Lyra R, Lyra R, Naves LA. Acromegaly: clinical features at diagnosis. Pituitary. 2017;20:22–32. https://doi.org/10.1007/s11102-016-0772-8
Colao A, Grasso LFS, Giustina A, Melmed S, Chanson P, Pereira AM, et al. Acromegaly. Nat Rev Dis Primer. 2019;5:20. https://doi.org/10.1038/s41572-019-0071- 6
Cortés HT, García WR, Giraldo CMG, Lomba AA, Tovar AP, Moreno LVS, et al. Consensus on the definition of diagnostic, therapeutic and follow-up criteria for acromegaly in Colombian patients. Rev Colomb Endocrinol Diabetes Metab. 2022;9(4):590-605. https://doi.org/10.53853/encr.9.4.780
Potorac I, Petrossians P, Daly AF, Schillo F, Slama CB, Nagi S, et al. Pituitary MRI characteristics in 297 acromegaly patients based on T2-weighted sequences. Endocr Relat Cancer. 2015;22(2):169–77. https://doi.org/10.1530/ERC-14-0305
Katznelson L, Laws ER, Melmed S, Molitch ME, Murad MH, Utz A, et al. Acromegaly: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 2014;99(11):3933–51. https://doi.org/10.1210/jc.2014-2700
Gheorghiu ML, Negreanu F, Fleseriu M. Updates in the Medical Treatment of Pituitary Adenomas. Horm Metab Res. 2020;52(01):8–24. https://doi.org/10.1055/a-1066-4592
Reincke M, Petersenn S, Buchfelder M, Gerbert B, Skrobek-Engel G, Franz H, et al. The German Acromegaly Registry: description of the database and initial results. Exp Clin Endocrinol Diabetes. 2006;114(9):498–505. https://doi.org/10.1055/s-2006-948313
Tschöp M, Weyer C, Tataranni PA, Devanarayan V, Ravussin E, Heiman ML. Circulating ghrelin levels are decreased in human obesity. Diabetes. 2001;50(4):707–9. https://doi.org/10.2337/diabetes.50.4.707
Bredella MA, Schorr M, Dichtel LE, Gerweck AV, Young BJ, Woodmansee WW, et al. Body Composition and Ectopic Lipid Changes With Biochemical Control of Acromegaly. J Clin Endocrinol Metab. 2017;102(11):4218–25. https://doi.org/10.1210/jc.2017-01210
Conaglen HM, de Jong D, Crawford V, Elston MS, Conaglen JV. Body Image Disturbance in Acromegaly Patients Compared to Nonfunctioning Pituitary Adenoma Patients and Controls. Int J Endocrinol. 2015;2015(1):624872. https://doi.org/10.1155/2015/624872
Leães CGS, Fernandes MV, Alves L, Araújo B, Rech CGSL, Ferreira NP, et al. Assessment of Anthropometric and Physical Health Indicators before and after Pituitary Surgery in Patients with Nonfunctioning Pituitary Adenomas, Acromegaly, and Cushing Disease. Indian J Endocrinol Metab. 2019;23(4):473–9. https://doi.org/10.4103/ijem.IJEM_301_19
Dupuy O, Petrossians P, Brue T, Morange I, Bordier L, Mayaudon H, et al. L’acromégalie du sujet âgé. Ann Endocrinol. 2009;70(4):225–9. https://doi.org/10.1016/j.ando.2009.05.002
Colao A, Amato G, Pedroncelli AM, Baldelli R, Grottoli S, Gasco V, et al. Gender- and age-related differences in the endocrine parameters of acromegaly. J Endocrinol Invest. 2002;25:532–8. https://doi.org/10.1007/BF03345496
Carvalho P, Lau E, Carvalho D. Surgery induced hypopituitarism in acromegalic patients: a systematic review and meta-analysis of the results. Pituitary. 2015;18:844–60. https://doi.org/10.1007/s11102-015-0661-6
Rick J, Jahangiri A, Flanigan PM, Chandra A, Kunwar S, Blevins L, et al. Growth hormone and prolactin-staining tumors causing acromegaly: a retrospective review of clinical presentations and surgical outcomes. J Neurosurg. 2018;131(1):147–53. https://doi.org/10.3171/2018.4.JNS18230
Alibas H, Uluc K, Kahraman-Koytak P, Uygur MM, Tuncer N, Tanridag T, et al. Evaluation of depressive mood and cognitive functions in patients with acromegaly under somatostatin analogue therapy. J Endocrinol Invest. 2017;40:1365–72. https://doi.org/10.1007/s40618-017-0722-y
Sievers C, Sämann PG, Pfister H, Dimopoulou C, Czisch M, Roemmler J, et al. Cognitive function in acromegaly: description and brain volumetric correlates. Pituitary 2012;15:350–7. https://doi.org/10.1007/s11102-011-0326-z
Isik K, Ba?o?ul C, Yildirim H. The relationship between perceived loneliness and depression in the elderly and influencing factors. Perspect Psychiatr Care. 2021;57(1):351–7. https://doi.org/10.1111/ppc.12572
Puglisi S, Terzolo M. Hypertension and Acromegaly. Endocrinol Metab Clin North Am. 2019;48(4):779–93. https://doi.org/10.1016/j.ecl.2019.08.008
Schutte AE, Volpe M, Tocci G, Conti E. Revisiting the relationship between blood pressure and insulin-like growth factor-1. Hypertens. 2014;63(5):1070–7. https://doi.org/10.1161/HYPERTENSIONAHA.113.03057
Ferraù F, Albani A, Ciresi A, Giordano C, Cannavò S. Diabetes Secondary to Acromegaly: Physiopathology, Clinical Features and Effects of Treatment. Front Endocrinol. 2018;9:358. https://doi.org/10.3389/fendo.2018.00358
Wennberg A, Lorusso R, Dassie F, Benavides-Varela S, Parolin M, De Carlo E, et al. Sleep disorders and cognitive dysfunction in acromegaly. Endocrine. 2019;66:634–41. https://doi.org/10.1007/s12020-019-02061-1
Kužma M, Killinger Z, Jackuliak P, Va?uga P, Hans D, Binkley N, et al. Pathophysiology of growth hormone secretion disorders and their impact on bone microstructure as measured by trabecular bone score. Physiol Res. 2019;68(2):S121–9. https://doi.org/10.33549/physiolres.934303
Terzolo M, Puglisi S, Reimondo G, Dimopoulou C, Stalla GK. Thyroid and colorectal cancer screening in acromegaly patients: should it be different from that in the general population? Eur J Endocrinol. 2020;183(4):D1–13. https://doi.org/10.1530/EJE-19-1009
Lenders NF, McCormack AI, Ho KKY. Management of endocrine disease: Does gender matter in the management of acromegaly? Eur J Endocrinol. 2020;182(5):R67–82. https://doi.org/10.1530/EJE-19-1023
Giustina A, Barkan A, Beckers A, Biermasz N, Biller BMK, Boguszewski C, et al. A Consensus on the Diagnosis and Treatment of Acromegaly Comorbidities: An Update. J Clin Endocrinol Metab. 2020;105(4):e937-e946. https://doi.org/10.1210/clinem/dgz096
Uzi?b?o-?yczkowska B, Jurek A, Witek P, Zieli?ski G, Gielerak G, Krzesi?ski P. Left Heart Dysfunction in Acromegaly Revealed by Novel Echocardiographic Methods. Front Endocrinol. 2020;11:418. https://doi.org/10.3389/fendo.2020.00418
Wassenaar MJE, Biermasz NR, Hamdy NAT, Zillikens MC, van Meurs JBJ, Rivadeneira F, et al. High prevalence of vertebral fractures despite normal bone mineral density in patients with long-term controlled acromegaly. Eur J Endocrinol. 2011;164(4):475–83. https://doi.org/10.1530/EJE-10-1005
Fleseriu M, Biller BMK, Freda PU, Gadelha MR, Giustina A, Katznelson L, et al. A Pituitary Society update to acromegaly management guidelines. Pituitary. 2021;24:1–13. https://doi.org/10.1007/s11102-020-01091-7
Bollerslev J, Heck A, Olarescu NC. MANAGEMENT OF ENDOCRINE DISEASE: Individualised management of acromegaly. Eur J Endocrinol. 2019;181(2):R57–71. https://doi.org/10.1530/EJE-19-0124
Esposito D, Ragnarsson O, Granfeldt D, Marlow T, Johannsson G, Olsson DS. Decreasing mortality and changes in treatment patterns in patients with acromegaly from a nationwide study. Eur J Endocrinol. 2018;178(5):459–69. https://doi.org/10.1530/EJE-18-0015
Giustina A, Barkhoudarian G, Beckers A, Ben-Shlomo A, Biermasz N, Biller B, et al. Multidisciplinary management of acromegaly: A consensus. Rev Endocr Metab Disord. 2020;21:667–78. https://doi.org/10.1007/s11154-020-09588-z
Alimohamadi M, Ownagh V, Mahouzi L, Ostovar A, Abbassioun K, Amirjmshidi A. The impact of immunohistochemical markers of Ki-67 and p53 on the long-term outcome of growth hormone-secreting pituitary adenomas: A cohort study. Asian J Neurosurg. 2014;9(03):130–6. https://doi.org/10.4103/1793-5482.142732
Bernabeu I, Aller J, Álvarez-Escolá C, Fajardo-Montañana C, Gálvez-Moreno Á, Guillín-Amarelle C, et al. Criteria for diagnosis and postoperative control of acromegaly, and screening and management of its comorbidities: Expert consensus. Endocrinol Diabetes Nutr. 2018;65(5):297–305. https://doi.org/10.1016/j.endinu.2018.01.008
Tovar H, Rojas W. Experiencia en acromegalia en el Hospital de San José: Acta Médica Colomb. 2010;35(2):48–52. https://doi.org/10.36104/amc.2010.1568
Dal J, Skov BG, Andersen M, Feldt-Rasmussen U, Feltoft CL, Karmisholt J, et al. Sex differences in acromegaly at diagnosis: A nationwide cohort study and meta-analysis of the literature. Clin Endocrinol (Oxf). 2020;94(4):625–35. https://doi.org/10.1111/cen.14392
Tanimoto K, Hizuka N, Fukuda I, Takano K, Hanafusa T. The influence of age on the GH-IGF1 axis in patients with acromegaly. Eur J Endocrinol. 2008;159(4):375–9. https://doi.org/10.1530/EJE-08-0243
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