Presentation and Outcomes in Patients Surgically Treated for Acromegaly at a Newly Established Pituitary Center

Objective We evaluated presentation, comorbidities and long-term outcomes of acromegaly at a newly established pituitary center. Design We conducted a retrospective chart review of patients who underwent surgery by a single skull-based-trained neurosurgeon between 7/2018-2/2024. We compared presentation and comorbidities in two groups of patients: A (postoperative remission), and B (persistent GH excess). Setting Tertiary referral academic medical center. Results Of the 50 patients (52% male, mean age at surgery 48.8±15.0 years) with GH-secreting adenoma, 8 (16%) were incidentally detected and 11 (22%) had prior surgery by another neurosurgeon. Men (vs women) were older, with more frequent hypopituitarism and vision changes at presentation. Group A (postoperative remission) included 25 patients. Low immediate postoperative GH levels (cutoff 1.705 ng/ml, AUC 0.81) predicted durable postoperative remission. Mean GH levels were lower in Group A (vs group B) throughout the postoperative follow-up period of 39.5 months (12.53, 51.58). Group B had more hyperglycemia (p 0.04) and overall comorbidities (p 0.03). Hyperglycemia was significantly associated with lower odds of postoperative remission (odds ratio 0.306, P = 0.043). At last follow-up (median 39.5 months; IQR 12.53; 51.58), 37/49 (75%) patients attained biochemical control, including 25 in group A and 12 in group B, the latter with additional therapy. Conclusion Acromegaly can be incidentally detected, hence IGF-1 measurement is indicated in all pituitary adenomas. Patients with persistent GH excess postoperatively have of a greater long-term burden of comorbidities and require multimodality therapy. Biochemical control is attainable at pituitary centers of expertise with dedicated neurosurgeons and endocrinologists.