The clinical features of acromegaly and its treatment policy according to age at the onset of disease

Abstract

The hormonal activity and the duration of an active phase of the disease are important factors that are involved in the pathogenesis of organ and system complications decreasing lifespan in patients with acromegaly. A hundred and forty patients with active acromegaly were examined to determine the age-related features of the course of the disease. According to the age by the moment of the examination, all the patients were divided into 3 groups: 1) 14 patients aged 20-39 years; 2) 72 patients aged 40-59 years; and 3) 54 patients aged 60 years or more. The mean age at the onset of disease was 27.5±1.9, 37.5±1.0, and 51.2±1.2 years in Groups 1, 2, and3, respectively (p - 0.000); the duration of a latent period being 3.8±0.7, 6.2±0 6, and 9.3±0 8years (p <0.002). The mean level of growth hormone as an indicator of secretory activity was 58.6±15.3, 41.2±5.9, and 20.5+3.5 ng/ml, respectively (P_1-3 - 0.007). In patients aged over 50 years at the onset of disease, the major factor of pathogenesis that negatively affected their survival is the duration of an active phase that favored the development of cardiovascular, respiratory, and metabolic diseases and malignant neoplasms, the severity of which substantially limits the capacity of a surgical intervention. The administration of somatostatin analogues in relative smaller doses is a more preferable treatment option. It is inadvisable to use dopamine agonists (without sensitivity being kept in mind) and radiotherapy (in an old age group).