Effectiveness of Combined First-Line Medical Treatment in Acromegaly with Prolactin Co-secretion.

Fecha de publicación: 01/06/2024 Fecha Ahead of Print: 01/06/2024

Autores de IIS La Fe

Rosa Cámara Gómez

Autor

Participantes ajenos a IIS La Fe

Biagetti, Betina
Araujo-Castro, Marta
Menendez Torre, Edelmiro
Novoa-Testa, Iria
Cordido, Fernando
Pascual Corrales, Eider
Rodriguez Berrocal, Victor
Guerrero-Perez, Fernando
Vicente, Almudena
Percovich, Juan Carlos
Garcia Centeno, Rogelio
Gonzalez, Laura
Ollero Garcia, Maria Dolores
Irigaray Echarri, Ana
Moure Rodriguez, Maria Dolores
Novo-Rodriguez, Cristina
Calatayud, Maria
Villar-Taibo, Rocio
Bernabeu, Ignacio
Alvarez-Escola, Cristina
Benitez Valderrama, Pamela
Tenorio, Carmen
Abellan Galiana, Pablo
Venegas Moreno, Eva
Gonzalez Molero, Inmaculada
Iglesias, Pedro
Blanco, Concepcion
Vidal-Ostos De Lara, Fernando
de Miguel, Paz
Lopez Mezquita, Elena
Hanzu, Felicia
Aldecoa, Iban
Aznar, Silvia
Lamas, Cristina
Aulinas, Anna
Asla, Queralt
Gracia, Paola
Recio Cordova, Jose Maria
Aviles, Mariola
Asensio-Wandosel, Diego
Sampedro, Miguel
Paja, Miguel
Ruz-Caracuel, Ignacio
Fajardo-Montanana, Carmen
Cordero Asanza, Esteban
Martinez-Saez, Elena
Marazuela, Monica
Puig-Domingo, Manel

Grupos

Unidad Mixta de Investigación en Endocrinología, Nutrición y Dietética clínica

Leader

Juan Francisco Merino Torres

Abstract

OBJECTIVE: To compare the response to first-line medical treatment in treatment-naive acromegaly patients with pure growth hormone (GH)-secreting pituitary adenoma (GH-PA) and those with GH and prolactin co-secreting PA (GH&PRL-PA). DESIGN: Retrospective multicentric study of acromegaly patients followed from 2003 to 2023 in 33 tertiary Spanish hospitals with at least six months of first-line medical treatment. METHODS: Baseline characteristics, first-line medical treatment strategies, and outcomes were analysed. We employed a multiple logistic regression full model to estimate the impact of some baseline characteristics on disease control after each treatment modality. RESULTS: Of the 144 patients included, 72.9% had a GH-PA, and 27.1% had a GH&PRL-PA. Patients with GH&PRL-PA were younger (43.9±15.0 vs. 51.9±12.7 years; p<0.01) and harboring more frequently macroadenomas (89.7% vs. 72.1%, p=0.03). First generation somatostatin receptor ligand (fgSRL) as monotherapy was given to 106 (73.6%) and a combination treatment with fgSRL and cabergoline in the remaining 38 (26.4%). Patients with GH&PRL-PA received more frequently a combination therapy (56.4% vs. 15.2%; p<0.01). After 6 months of treatment, in the group of patients under fgSRL as monotherapy, those patients with GH&PRL-PA had worse control compared to GH-PAs (29.4% vs. 55.1%, p=0.04). However, these differences in the rate of disease control between both groups disappeared when both received combination treatment with fgSRL and cabergoline. CONCLUSION: In GH&PRL-PA the biochemical control achieved with fgSRL as monotherapy is substantially worse than in patients harboring GH-PA, supporting the inclusion of cabergoline as first line medical treatment in combination with fgSRLs in these subgroups of patients.