ANALYSIS OF SEX- AND AGE-RELATED DIMORPHISM IN THE CLINICAL COURSE OF ACROMEGALY

Abstract

The aim of the study is to analyze the gender and age-related characteristics of the clinical course of acromegaly, taking into account the secretory activity and growth rate of pituitary adenomas.

Materials and methods. We examined 133 patients (88 women and 45 men) with the pituitary form of acromegaly (including 47 patients de novo) (somatotropinoma (ST) (n=95) and somatomammotropinoma (SMT) (n=38)). The age of patients in the general group ranged from 15 to 75 (Me 45.0) years. The total duration of the disease ranged from 1 to 38 (Me 10.0) years. The assessment of clinical and hormonal disease control was conducted according to the provisions of the 2024 consensus. Levels of pituitary growth hormone (GH), prolactin and insulin-like growth factor-1 in the blood were determined using the immunochemiluminescent methods. Partial secretory activity of the pituitary adenoma and tumor growth rate were also evaluated according to V. Pronin. Statistical analysis of the study results was performed using the software package "Statistical 13.0" (Stat Soft Inc., USA).

Results and conclusions. Analysis of the gender composition of the general sample showed a predominance of women (1:1.9), which persisted in the patient groups ST and SMT (1:1.4 and 1:2.2, respectively). The age of patients in the ST and SMT groups was comparable ((44.0±12.6) and (44.0±12.0) years, respectively). The proportion of patients aged 31 to 60 years in the sample was 88.7% (men and women 26.3% and 54.8%, respectively) (P<0.0001). The 'peak' of acromegaly manifestation occurred at the most productive age (41.3±12.0 years), in men – (39.0±13.2) and in women – (42.8±11.0) years. In 13.5% of patients, acromegaly manifested at the age of over 50 years. Only 20.6% of those examined were diagnosed with acromegaly within a year of the onset of the first symptoms. In 8.27% of patients, clinical and hormonal control of acromegaly was adequate, in 23.3% – inadequate, and in 68.5% – poor.

It has been established that with an increase in the patient's age at the time of acromegaly manifestation, there is a lengthening of the preclinical period and a decrease in the secretory and proliferative activity of the pituitary adenoma. The sexual dimorphism in the clinical course of acromegaly are a younger age at disease onset, higher total and lower partial secretory activity of GH-secreting pituitary adenomas in men compared to women. The clinical-biochemical pattern of a patient with acromegaly with a 'rapidly progressing' course of the disease is represented by a young age at disease onset, high total and low partial secretory activity of the GH-secreting pituitary adenoma, and a high rate of tumor growth; for a 'slowly progressing' course – an older age at disease onset, with the secretory activity of the pituitary adenoma predominating over its proliferative activity.