Malignancy in patients with acromegaly: a multicenter study across the Gulf region.

Abstract

Background: Chronic growth hormone and insulin-like growth factor 1 excess may promote tumorigenesis, but the magnitude of malignancy risk in acromegaly remains uncertain and regional data from the Gulf are limited.

Objective: To describe the frequency, spectrum, detection, outcomes, and clinical correlates of malignancy among patients with acromegaly treated across Gulf tertiary centers.

Design: Multicenter retrospective observational study.

Setting: Five tertiary centers across Saudi Arabia, Qatar, and the United Arab Emirates.

Patients and methods: Medical records of patients aged >16 years with acromegaly who were evaluated from 2010 through 2024 were reviewed. Demographic, disease, treatment, cancer-testing, and malignancy data were collected. Group comparisons were descriptive and exploratory because only 10 malignancies occurred.

Main outcome measures: Documented malignancy frequency, cancer type, method of detection, stage, treatment, outcome, and clinical correlates.

Sample size: 157 patients.

Results: The mean age was 47.1 years, 101 patients (64.3%) were male, and the mean disease duration was 9.4 years. Malignancy was documented in 10 patients (6.4%), most commonly papillary thyroid carcinoma (8/10). Two of the eight papillary thyroid carcinomas were classified as T1a (≤10 mm); exact pathology measurements were not consistently available. One patient had colorectal cancer, and one had prostate cancer. Exploratory comparisons showed that patients with malignancy were older than those without malignancy (mean age, 56.6 vs 46.5 years; P=.039). The remaining comparisons were inconclusive. All patients with malignancy were in remission or had an excellent response at the last documented follow-up.

Conclusion: Malignancy was documented in 6.4% (10 out of 157) in this multi-center Gulf acromegaly cohort, predominantly papillary thyroid carcinoma. The findings support individualized surveillance based on population guidance, symptoms, family history, and clinical findings rather than an acromegaly-specific screening program.

Limitations: Retrospective design, small number of malignancy events, missing data, lack of a population comparator, and nonstandardized cancer testing may introduce selection and detection biases.