Predictors of biochemical and structural response to medical therapy in patients with active acromegaly following surgery: a real-world perspective
Abstract Background Somatostatin receptor analogs (SRAs) and dopamine agonists (DAs) are the main medical treatments for patients with acromegaly who fail to achieve remission after surgery. We aimed to explore the potential role of select clinical, biochemical, and radiological factors in predictin...
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BMC
2025-02-01
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| Series: | BMC Endocrine Disorders |
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| Online Access: | https://doi.org/10.1186/s12902-025-01856-w |
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| author | Maryam Rafieemanesh Manizhe Ataee Kachuee Ali Zare Mehrjardi Alireza Khajavi Mohammad Ghorbani Mohammad Reza Mohajeri-Tehrani Nahid Hashemi-Madani Mohammad E. Khamseh |
| author_facet | Maryam Rafieemanesh Manizhe Ataee Kachuee Ali Zare Mehrjardi Alireza Khajavi Mohammad Ghorbani Mohammad Reza Mohajeri-Tehrani Nahid Hashemi-Madani Mohammad E. Khamseh |
| author_sort | Maryam Rafieemanesh |
| collection | DOAJ |
| description | Abstract Background Somatostatin receptor analogs (SRAs) and dopamine agonists (DAs) are the main medical treatments for patients with acromegaly who fail to achieve remission after surgery. We aimed to explore the potential role of select clinical, biochemical, and radiological factors in predicting biochemical and structural responses to medical therapy in a real-world setting. Methods This retrospective cohort study included 58 patients with active acromegaly following surgery treated with Octreotide long-acting release (LAR) (± Cabergoline). Biochemical outcomes were defined as the tight biochemical response (TBR; normal insulin-like growth factor-1(IGF-1)) and biochemical control (BC; IGF-1 ≤ 1.2 upper limit of normal (ULN)). The structural response was defined as > 25% reduction in one dimension of the tumor at the last visit. Univariate and multivariate analyses assessed the predictors of biochemical and structural response. Results The mean age of the participants was 41.5 ± 11.7 years. They were followed for a median of 27.6 (19.2–43.2) months. At the last visit, TBR and BC were achieved in 48.3% and 51.7% of the patients. Moreover, 51.4% of the patients showed a structural response. Applying the age-sex adjusted model, post-operative IGF-1 was inversely associated with TBR [OR 0.34, P = 0.006] and BC [OR 0.30, P = 0.004]. Moreover, Knosp grading < 3 compared to ≥ 3, and T2-hypointensity compared to the non-T2-hypointensity were associated with higher odds of TBR [OR 3.98, P = 0.04], [OR 27.63, P = 0.01], and BC [OR 5.80, P = 0.01], [OR 35.15, P = 0.01], respectively. Conclusions Post-operative IGF-1, Knosp grading, and T2-hypointensity could be considered for an individualized treatment plan in acromegaly. Accordingly, we propose an individual multidisciplinary treatment approach for patients not achieving remission after surgery. |
| format | Article |
| id | doaj-art-fea659f54f074f5c9ee0a35d8dbbb193 |
| institution | Kabale University |
| issn | 1472-6823 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | BMC |
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| series | BMC Endocrine Disorders |
| spelling | doaj-art-fea659f54f074f5c9ee0a35d8dbbb1932025-02-09T12:41:13ZengBMCBMC Endocrine Disorders1472-68232025-02-012511910.1186/s12902-025-01856-wPredictors of biochemical and structural response to medical therapy in patients with active acromegaly following surgery: a real-world perspectiveMaryam Rafieemanesh0Manizhe Ataee Kachuee1Ali Zare Mehrjardi2Alireza Khajavi3Mohammad Ghorbani4Mohammad Reza Mohajeri-Tehrani5Nahid Hashemi-Madani6Mohammad E. Khamseh7Endocrine Research Center, Institute of Endocrinology and Metabolism, Department of Internal Medicine, School of Medicine, Iran University of Medical SciencesDepartment of Radiology, Firoozgar Clinical Research Development Center (FCRDC), Iran University of Medical SciencesDepartment of Pathology, Firoozgar Hospital, Iran University of Medical SciencesSchool of Allied Medical Sciences, Shahid Beheshti University of Medical SciencesDivision of Vascular and Endovascular Neurosurgery, Firoozgar Hospital, Iran University of Medical SciencesEndocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical SciencesEndocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical SciencesEndocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical SciencesAbstract Background Somatostatin receptor analogs (SRAs) and dopamine agonists (DAs) are the main medical treatments for patients with acromegaly who fail to achieve remission after surgery. We aimed to explore the potential role of select clinical, biochemical, and radiological factors in predicting biochemical and structural responses to medical therapy in a real-world setting. Methods This retrospective cohort study included 58 patients with active acromegaly following surgery treated with Octreotide long-acting release (LAR) (± Cabergoline). Biochemical outcomes were defined as the tight biochemical response (TBR; normal insulin-like growth factor-1(IGF-1)) and biochemical control (BC; IGF-1 ≤ 1.2 upper limit of normal (ULN)). The structural response was defined as > 25% reduction in one dimension of the tumor at the last visit. Univariate and multivariate analyses assessed the predictors of biochemical and structural response. Results The mean age of the participants was 41.5 ± 11.7 years. They were followed for a median of 27.6 (19.2–43.2) months. At the last visit, TBR and BC were achieved in 48.3% and 51.7% of the patients. Moreover, 51.4% of the patients showed a structural response. Applying the age-sex adjusted model, post-operative IGF-1 was inversely associated with TBR [OR 0.34, P = 0.006] and BC [OR 0.30, P = 0.004]. Moreover, Knosp grading < 3 compared to ≥ 3, and T2-hypointensity compared to the non-T2-hypointensity were associated with higher odds of TBR [OR 3.98, P = 0.04], [OR 27.63, P = 0.01], and BC [OR 5.80, P = 0.01], [OR 35.15, P = 0.01], respectively. Conclusions Post-operative IGF-1, Knosp grading, and T2-hypointensity could be considered for an individualized treatment plan in acromegaly. Accordingly, we propose an individual multidisciplinary treatment approach for patients not achieving remission after surgery.https://doi.org/10.1186/s12902-025-01856-wAcromegalySomatostatin receptor analogsDopamine agonistsBiochemical responseStructural response |
| spellingShingle | Maryam Rafieemanesh Manizhe Ataee Kachuee Ali Zare Mehrjardi Alireza Khajavi Mohammad Ghorbani Mohammad Reza Mohajeri-Tehrani Nahid Hashemi-Madani Mohammad E. Khamseh Predictors of biochemical and structural response to medical therapy in patients with active acromegaly following surgery: a real-world perspective BMC Endocrine Disorders Acromegaly Somatostatin receptor analogs Dopamine agonists Biochemical response Structural response |
| title | Predictors of biochemical and structural response to medical therapy in patients with active acromegaly following surgery: a real-world perspective |
| title_full | Predictors of biochemical and structural response to medical therapy in patients with active acromegaly following surgery: a real-world perspective |
| title_fullStr | Predictors of biochemical and structural response to medical therapy in patients with active acromegaly following surgery: a real-world perspective |
| title_full_unstemmed | Predictors of biochemical and structural response to medical therapy in patients with active acromegaly following surgery: a real-world perspective |
| title_short | Predictors of biochemical and structural response to medical therapy in patients with active acromegaly following surgery: a real-world perspective |
| title_sort | predictors of biochemical and structural response to medical therapy in patients with active acromegaly following surgery a real world perspective |
| topic | Acromegaly Somatostatin receptor analogs Dopamine agonists Biochemical response Structural response |
| url | https://doi.org/10.1186/s12902-025-01856-w |
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