Object Acromegaly, a syndrome of excess growth hormone (GH) secretion typically caused by a GH-secreting pituitary adenoma, reduces life expectancy by approximately 10 years when left untreated. Treatment of acromegaly involves combinations of one or more discrete therapeutic modalities to achieve biochemical control. Unfortunately, data capable of informing decisions among alternate management strategies are presently lacking. Methods The authors performed a comparative effectiveness research (CER) review integrating efficacy, cost, and quality of life (QOL) analysis for treatment strategies comprising various combinations of surgery, radiotherapy, stereotactic radiosurgery, and pharmacotherapy in patients with acromegaly caused by a pituitary microadenoma. A management decision tree was used to identify 5 treatment strategies, each with up to 4 potential treatment steps. Efficacy was assessed using recent literature reports of biochemical control rates for each modality. Cost estimations were derived from wholesale drug prices and from the Healthcare Cost and Utility Project. Quality of life data were obtained from studies utilizing the Acromegaly Quality of Life Questionnaire. Results Individual treatment modalities were analyzed and ranked in each of 3 domains: highest rate of success, lowest cost, and highest QOL, and these scores were combined to facilitate comparison of overall effectiveness of each of the management strategies. These aggregate effectiveness scores were used to compare the 5 strategies from the decision tree, and a novel strategy was also proposed. Conclusions The choice of management strategy must be individualized for each patient with acromegaly. This CER analysis provides a comprehensive framework to inform clinical decisions among alternate management strategies in patients with GH-secreting pituitary microadenomas.

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INTRODUCTION: This study assessed the attitudes, knowledge and experiences caring for lesbian, bisexual, and transgender (LBT) patients among members of a national group of obstetrician-gynecologists. METHODS: Members of the American College of Obstetricians and Gynecologists (the College) who attended College meetings in Denver and Indiana completed a survey assessing care practices, knowledge and attitudes toward LBT patients. RESULTS: 196 out of 425 (46.1%) physicians completed the survey. Most physicians often or sometimes ask about sexual orientation, but they rarely ask about gender identity. Over 98% feel comfortable treating lesbian and bisexual patients, but 30% believe a provider should be allowed to decline to treat LBT patients if it conflicts with the provider’s religious beliefs. Over 84% agree that their workplace is a safe place for LGBT patients, but most do not have or know if they have office measures that would create a welcoming space, such as posted nondiscrimination policies or LGBT employee training. The majority screen LBT patients at the same rate as non-LBT patients for depression, substance abuse, and cervical cancer. Physicians reported that self-directed learning and experiences with LBT patients were more valuable forms of LBT education than formal training in medical school, residency or CME. CONCLUSION: Physicians in obstetrics and gynecology recognize and address issues regarding sexual orientation. Physicians feel comfortable treating LBT patients but are dissatisfied with formal training they receive on LBT health issues. While most believe that their workplaces are safe environments for LBT patients, much more can be done to ensure that patients perceive them to be safe.