Improving treatment decisions in acromegaly and adult-onset growth hormone deficiency
Improving treatment decisions in acromegaly and adult-onset growth hormone deficiency
This thesis of Mark Postma aims to improve clinical care for patients with acromegaly and adult-onset growth hormone deficiency (AGHD) by examining treatment outcomes and the factors influencing them.
For acromegaly, Chapter 2 shows that postoperative use of somatostatin analogs (SSA) does not increase mortality in patients who achieve adequate disease control, whereas inadequate control, craniotomy, and glucocorticoid use are linked to higher mortality. Chapter 3 finds that prolonged SSA use after surgery is associated with impaired quality of life, despite similar IGF-1 levels. Chapter 4, the largest multicenter study available in the literature on clinical predictors for remission after transsphenoidal surgery (TSS), identifies that smaller tumors and lower growth hormone levels at diagnosis predict better outcomes, while younger patients with larger tumors are more prone to relapse. Chapter 5 presents a case of acromegaly due to an agressive tumor subtype, highlighting the need for biomarkers to guide treatment.
For AGHD, Chapter 6 shows no difference in treatment response between early or late initiation of growth hormone replacement therapy (GHRT). Chapter 7 demonstrates that four years of GHRT improve body composition but do not clearly affect cardiovascular risk factors.
Chapter 8 reveals variability in IGF-1 measurements across centers in the Netherlands due to inconsistent use of reference values and guidelines adherence, impacting clinical decisions. These findings highlight the need for standardized practices and personalized treatment strategies to optimize outcomes in acromegaly and AGHD care.