| Background:Acromegaly is a rare chronic disease,mainly caused by elevated serum growth hormone and Insulin like growth factor 1 induced by pituitary growth hormone adenoma.Hypertrophy of hands and feet as well as facial changes are the most prominent clinical manifestations of this disease.In addition,acromegaly patients are often accompanied by a variety of chronic comorbidities.The goal of treatment for these patients is to eliminate tumors,reduce blood GH and IGF-1 concentrations,so as to improve the symptoms of patients and reduce the incidence of comorbidities.Surgical resection is the main treatment,other method including drug therapy,radiotherapy and combined therapy.SAGIT score is a clinical evaluation tool for acromegaly proposed in recent years,it involves comprehensive and targeted projects,and is an effective tool for the management of acromegaly patients.Because the incidence of acromegaly is low and the large-scale studies are insufficient,retrospective analysis with a large sample size in a single center is of great significance in improving the cognition of acromegaly and summarizing disease management methods.Objective:The purpose of this study is to retrospectively analyze a large sample of patients with pituitary growth hormone adenoma from a single center in Peking Union Medical College Hospital,to summarize the clinical characteristics of patients with pituitary growth hormone adenoma in terms of symptoms,comorbidities,hormone levels,imaging,pathology and other aspects,and to analyze the influencing factors of the cure rate of the disease.Methods:In this study,clinical information was collected in 519 patients with pituitary growth hormone adenoma who were admitted to Peking Union Medical College Hospital(From 2015 to 2018),follow-up records are complete in all patients.With the help of SPSS software,the generalized likelihood test,correlation analysis,regression analysis,prediction curve and other statistical analysis were carried out on the above data.Results:The ratio of female to male was about 1.29:1,the average course of disease was 76 months,and the common comorbidities included sleep apnea,hypertension,diabetes,etc.The incidence of hypofunction of gonadal axis,adrenal axis and thyroid axis was 25.2%,5.8%and 5.6%,respectively.The postoperative recovery rates was 63.3%,69.0%and 75.0%.The mean follow-up time of all patients was 38.2±8.3 months.The endocrine cure rate was 52.0%after surgery.The cure rate of patients with large adenoma,invasive adenoma and high preoperative GH was significantly lower(P<0.001).Microadenoma patients accounted for 23.9%,and macroadenoma patients accounted for 76.1%.The maximum diameter of the growth hormone adenoma was correlated with the characteristics of tumor invasion and the cure rate(P>0.001).The cure rates of microscopy transsphenoidal surgery group(389 cases)and endoscopy transsphenoidal surgery group(122 cases)was 50.1%and 59.0%,respectively(P>0.05).The cut-off value of SAGIT score was 11.5(sensitivity 72.7%,specificity 76.3%)to predict patients'cure status.Conclusion:Acromegaly patients have a long course of disease and various comorbidities,and the severity of the disease is closely related to tumor size,aggressiveness,pathological type and growth hormone concentration,etc.Surgery is an effective method to reduce hormone levels and relieve symptoms.SAGIT score can be used to evaluate the patient's condition and predict the outcome of treatment,which has a good reference value for disease management and is an effective supplement for evaluation in this disease. |
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