Multidisciplinary management of acromegaly: A consensus

Abstract

The 13th Acromegaly Consensus Conference was held in November 2019 in Fort Lauderdale, Florida, and comprised acromegaly experts including endocrinologists and neurosurgeons who considered optimal approaches for multidisciplinary acromegaly management. Focused discussions reviewed techniques, results, and side effects of surgery, radiotherapy, and medical therapy, and how advances in technology and novel techniques have changed the way these modalities are used alone or in combination. Effects of treatment on patient outcomes were considered, along with strategies for optimizing and personalizing therapeutic approaches.Expert consensus recommendations emphasize how best to implement available treatment options as part of a multidisciplinary approach at Pituitary Tumor Centers of Excellence.

Results from ACROCOVID: an international survey on the care of acromegaly during the COVID-19 era

“…Acromegaly is a chronic disease which, if not adequately controlled, heavily impacts on quality of life and survival due to its many systemic comorbidities [10,13,17]. However, the well-known clinical challenges in the management of the disease, i.e., persistent lengthy diagnostic delays [18], which lead to a high prevalence of macroadenomas at presentation with the need for strict control of pituitary tumor growth [19] and the frequent need for multimodal treatment in Pituitary Tumors Centers of Excellence (PTCOE) [20][21][22] are likely to be heavily affected by systemic rearrangements and ongoing crises in healthcare during the COVID-19 pandemic.…”

“…In this light, it is reassuring to note that care was continued in the vast majority of cases. Furthermore, SSA are able to control tumor growth, and induce tumor shrinkage, in most patients with acromegaly [28,29] and can be a valid option when surgery is delayed [13]. This consideration is increasingly important currently given many endocrinologists reported major difficulties in the neuroradiological follow-up of their patients.…”

“…As a result of the non-specific nature of some of the presenting symptoms, and the frequently subtle progression of clinical features, diagnosis is often delayed [10][11][12]. Treatment typically requires a multidisciplinary team of health care professionals including endocrinologists, neurosurgeons, and specialized endocrine nurses [13,14], and access to these professionals could potentially be severely limited under COVID-19 pandemic conditions [15,16]. Hence, patients may face the prospect of even more prolonged delays in both diagnosis and implementation of effective treatment plans in many centers worldwide.…”

Disease and Treatment-Related Burden in Patients With Acromegaly Who Are Biochemically Controlled on Injectable Somatostatin Receptor Ligands

“…Excess production of growth hormone (GH) and insulin-like growth factor 1 (IGF-1) can result in symptoms such as changes in appearance and enlargement of hands and feet, as well as fatigue, joint pain, and systemic complications including cardiovascular disease and respiratory disease (5)(6)(7). Somatostatin receptor ligands (SRLs) are the most common first-line medical treatment (8)(9)(10)(11) and are administered as either long-acting intramuscular (octreotide LAR) or deep subcutaneous injections (lanreotide autogel). SRLs are successful in achieving biochemical control in just over half of those treated (1).…”

La importancia del Consenso Nacional de Acromegalia: una perspectiva histórica

“…Por otra parte, muchos se cuestionarán también si es necesario contar con un consenso nacional de acromegalia, cuando desde el Consenso de Cortina del año 2000 han tenido lugar 10 consensos internacionales que cubren prácticamente todos los aspectos de esta enfermedad, incluyendo el diagnóstico, las comorbilidades, el tratamiento y el seguimiento de la acromegalia [6][7][8][9][10][11][12][13][14] . En mi opinión, la respuesta a esta pregunta es afirmativa y la justificación estriba en que existen diferencias en el manejo de enfermedades de baja prevalencia y alto costo entre países desarrollados y países en vías de desarrollo como el nuestro.…”