Medical Treatment with Somatostatin Analogues in Acromegaly: Position Statement

Precision Therapy in Acromegaly Caused by Pituitary Tumors: How Close Is It to Reality?

“…Clinical [2,24,55,[63][64][65][66] and imaging [9,23,24] features of the patient, histological and molecular characteristics of the tumor [23,25,26,[28][29][30]34] (more details in Fig. 1) may be coalesced into clinical guidelines [20], while more markers are being researched [29,[31][32][33][36][37][38]61].…”

“…Median age at diagnosis in South Korea is 44.1, following the 40.5 to 51.7 age range in other studies to date ( www.e-enm.org 209 in either gender (Table 1) [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][39][40][41][42][43][44][45][46]. One of the major contributors to high morbidity in acromegaly is the delay in diagnosis, which according to recent studies is approximately 5 years [12,14,21].…”

“…Initial selection of SSA and subsequent switch to another drug type, judging by the absence of disease control, have most perilous disadvantages, when considering the delay in cure and worsening of patient quality of life [22]. Individualized management guidelines [20] can be directed by the advances in translational research, which can yield markers of responsiveness to surgery or medical therapy.…”

“…Removal of tumor pseudocapsule during transsphenoidal adenomectomy (TSA) improves endocrinological remission rates and no increased risk of postoperative hypopituitarism or cerebrospinal fluid rhinorrhea [55,65]. Somatotropinomas present as macroadenomas (>10 mm in diameter) in 65% to 89% (Table 1) [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][39][40][41][42][43][44][45][46], decreasing the possibility of complete surgical cure and evoking persistent disease in >60% of cases [9]. Gamma knife surgery should be avoided in patients with cavernous sinus invasion, owing to the risk of hypopituitarism and radiation necrosis [49].…”

“…Albeit a rare disease, population-based studies have been able to determine the prevalence, ranging from 28 to 134 cases per million (cpm) and the incidence, ranging from 1.9 to 11 cpm per year [7][8][9][10][11][12][13][14][15][16][17][18][19]. Median age at diagnosis is within the fifth decade of life, but owing to the small population sizes it is hard to infer www.e-enm.org 207 differences in gender [20,21]. Majority of the epidemiological data has come from Europe [7,[9][10][11][12]14,[16][17][18], but some representative countries, like South Korea in Asia have also made such contributions via multi-center [13] and claims database studies [15].…”