Clinical features and therapeutic outcomes of patients with acromegaly in Saudi Arabia: a retrospective analysis.

BACKGROUND: Acromegaly is a rare disease resulting in clinical sequelae with significant morbidity and mortality due to the central tumor mass effect and prolonged growth hormone (GH) hypersecretion. OBJECTIVES: The goal is to describe the epidemiology, clinical features, presence of comorbidities, and treatment outcomes of acromegaly in Saudi Arabia. METHODS: Data was collected through a retrospective review of the charts of all patients diagnosed with acromegaly from nine major hospitals in Saudi Arabia over a period of more than 25 years. RESULTS: A total of 195 patients (116 males and 79 females), with a mean age at diagnosis of 43 ± 12 (males) and 46 ± 14 years (females), from nine major hospitals were identified and included in the analysis. All cases were caused by pituitary adenomas, of which 92.4% were macroadenomas. Headache, coarse facial features, acral growth, and sweating/oily skin were by far the most frequent presenting complaints. The most common comorbidities were diabetes mellitus (51.7%), followed by hypertension (50%) and visual field defect (30.5%). The vast majority (95%) of patients were treated surgically (98%). Twenty-four percent also received radiotherapy, and 74.4% received medical therapy. When stringent criteria were applied for assessment of outcomes of therapy, 28.7% of the patients were cured and 30.1% had their disease under control, while 28.7% were found to have active disease despite receiving multimodal therapy. CONCLUSIONS: Our findings highlight the need for a national acromegaly registry to enable early identification, evaluation, and selection of the best therapeutic approaches to improve the outcome and remission rate of the disease.

High rate of persistent/recurrent disease among patients with differentiated thyroid cancer in Saudi Arabia: factors affecting nonremission.

BACKGROUND AND OBJECTIVES: A fairly high number of patients with differentiated thyroid cancer (DTC) in our center had locally advanced disease at presentation and/or persistent disease after standard treatment. Therefore, we conducted a retrospective study to find the rate of successful ablation and remission and the factors affecting these outcomes. METHODS: The study included 100 consecutively treated patients (20 males, 80 females; median age 36 years) diagnosed with DTC. Univariate and multivariate logistic regression was used to evaluate the effect of risk factors on the persistence or recurrence of thyroid cancer. All patients underwent total thyroidectomy and had cervical lymph node dissection when indicated. All patients received sodium iodide I 131 ablation once or twice post surgery. Patients were followed clinically by neck ultrasound, (123)I whole body scan and by thyroglobulin measurements and other diagnostic tests as needed. RESULTS: Over a median follow-up of 7.6 years (range 7-10 years), ablation occurred in 93%, remission in 50%, disease persisted without remission in 41%, and 9% had recurrence after at least 1 year of remission. Papillary thyroid cancer was found in 76%, the follicular variant in 14%, other variants (tall cell and sclerosing types) in 2%, Hurthle cell carcinoma in 4%, and pure follicular thyroid cancer in 4%. Compared with patients in remission, patients with persistent/recurrent disease were older (mean 41 versus 31 years, P=.003), had higher postoperative thyroglobulin (193 versus 29 ng/mL, P=.04) and more advanced TNM staging (P=.005). Risk factors significant for non-remission were age >40 years (odds ratio 4.1, 95% CI 1.5-10.9 years, P=.003) and TNM stage other than 1 (odds ratio 5.5, 95% CI 1.9-16.3, P=.001). Only TNM Stage 1 was significant for remission in the multivariate analysis. CONCLUSION: The low remission rate in our DTC patients is probably due to more advanced disease at time of presentation. Early detection may, therefore, be essential in improving outcome.

Preoperative neck ultrasonographic mapping for persistent/recurrent papillary thyroid cancer.

Surgical resection of persistent/recurrent (P/R) papillary thyroid cancer (PTC), when localized to the neck, is generally recommended; however, its impact on the course of the disease is not clear. We introduced a new technique in the form of preoperative neck ultrasonographic mapping (US-M) to improve the outcome of the surgical resection of P/R PTC. A total of 19 patients had undergone regional (central, lateral, or both) neck dissection before introducing the current technique (group 1, or G1), and 26 patients (group 2, or G2) had limited lymph node resection guided by US-M with findings accurately plotted on a standard diagram. All of the operations were performed by a single surgeon. The surgical outcomes of the two groups were compared. The resected lesions were positive for PTC in 17 patients (89.5%) in G1 and in 25 patients (96.2%) in G2. In G2, the intraoperative findings exactly matched the US-M in 23 patients (88.5%). Postoperatively, neck US became negative in 50% in G1 and in 83.3% in G2 (p = 0.02). Thyroglobulin (Tg) became undetectable in 37.5% in G1 and 52.3% in G2 (p = 0.37). Whole-body iodine scans (WBS) became negative in one of six patients (16.7%) in G1, and in three of four patients (75%) in G2, (p = 0.06). After a mean follow-up of 23.8+/-7.1 months in G1 and 9.8+/-4.7 months in G2, 6 patients (31.6%) in G1 and 15 patients (62.5%) in G2 were in remission (p = 0.04), whereas the disease persisted in 13 cases (68.4%) in G1 and 9 (37.5%) in G2 (p = 0.04). In conclusion, US-M improved the surgical outcome, as evidenced by the postoperative US, Tg, and WBS findings and the higher remission rate for the G2 patients than for the G1 patients.