A consensus on the diagnosis and treatment of acromegaly complications

Abstract

In March 2011, the Acromegaly Consensus Group met to revise and update the guidelines on the diagnosis and treatment of acromegaly complications. The meeting was sponsored by the Pituitary Society and the European Neuroendocrinology Association and included experts skilled in the management of acromegaly. Complications considered included cardiovascular, endocrine and metabolic, sleep apnea, bone diseases, and mortality. Outcomes in selected, related clinical conditions were also considered, and included pregnancy, familial acromegaly and invasive macroadenomas. The need for a new disease staging model was considered, and design of such a tool was proposed.

Sleep apnea syndrome in acromegalic patients: Can morphological evaluation guide us to optimize treatment?

“…Different series have noted a relatively high prevalence (45-80 %), which is significantly higher than that of the general population (2-4 %) [1,2], although it is probably still under-assessed [3]. In this setting, a recent consensus on acromegaly complications stated that every patient should undergo a careful symptomatic [for example, with an Epworth Sleepiness scale score (ESS)] and/or laboratory assessment for SAS at the time of diagnosis, in collaboration with a respiratory physician [3]. Obstructive SAS (OSAS) is the prevailing form in acromegaly; this occurs due to craniofacial deformations, hypertrophy of pharyngeal soft tissue, macroglossia and thickening of upper airway, all of which hamper the airflow through upper airways.…”

“…This inconsistency regarding the resolution of SAS despite successful acromegaly treatment advocates for the need to perform a post-treatment evaluation, as it was recommended by the Acromegaly Consensus Group [3], not only in patients with partial or no response to GHlowering therapies, but also after biochemical normalization. When biochemical control is achievable, soft tissue hypertrophy may reverse and OSAS may improve with acromegaly-directed treatment.…”

“…On the contrary, however, persistence of the respiratory disorder could be due to residual and irreversible skeletal and craniofacial deformations already established. At this time, consultation with maxillofacial surgeons is advised [3], and elective surgery may be necessary. So, once again, we highlight the importance of a prompt evaluation.…”

Expert consensus document: A consensus on the medical treatment of acromegaly

“…Surgical, pharmacological and radiotherapeutic approaches are used to treat acromegaly, and consensus statements and guidelines on acromegaly management and management of complications have been updated. [4][5][6][7] Moreover, during the 2013 meeting, detailed guidance on pharmacological options for acromegaly treatment was revisited by the group and current recommendations are presented here. Recommendations were graded on the basis of the Grading of Recommendations Assessment, Development and Evaluation system (Box 1).…”

Vitamin D-binding protein: one more piece in the puzzle of acromegalic osteopathy?

“…Although the exact role of vitamin D deficiency in the pathogenesis of GH excess-induced skeletal fragility is still unknown, low vitamin D values were associated with vertebral fractures in post-menopausal women [27] but not in males [28] with acromegaly and correction of vitamin D deficiency has been recommended as one of main measures in the management of skeletal fragility in this clinical setting [29]. Unfortunately, the study of Altinova et al did not provide data concerning skeletal health in their acromegaly patients [20].…”