Acromegaly in the developing world - a 20-year teaching hospital experience

A retrospective analysis was conducted to examine the long-term outcome of surgery, by a single pituitary surgeon and radiotherapy for acromegaly at G roote Schuur Hospital, Cape Town, using modern criteria for the definition of cure. Seventy-two patients (F/M ratio 1.3:1), aged 16-74 years, were eli gible for inclusion. The mean follow-up period was 8.3 years. Macroadenomas were present in 79%, microadenomas in 15% and tumour size was not document ed in 6%. Pretreatment GH levels were, 40 m U/l in 56 patients. Postoperati vely, 21% of patients were cured, 40% controlled and 40% had hypopituitaris m. After radiotherapy (mean follow-up 8.7 years) 43% were cured, 66% contro lled and 78% had hypopituitarism. At follow-up 37% of patients traced had d ied. The most common cause of death was vascular disease. The poor surgical results may be attributed to late presentation in the developing world set ting, as evidenced by tumour size and invasiveness, and the degree of GH el evation. Emphasis on early diagnosis of non-invasive tumours is necessary t o improve the cure rate and reduce mortality.