Predictive biomarkers in the treatment of acromegaly: a review of the literature

Przhiyalkovskaya, Elena; Георгиевна, Пржиялковская Елена; Osmanova, Patimat O.; Османовна, Османова Патимат; Mamedova, Elizaveta; Октаевна, Мамедова Елизавета; Lutsenko, Alexander; Сергеевич, Луценко Александр; Belaya, Zhanna; Евгеньевна, Белая Жанна; Мельниченко, Г. А.; Афанасьевна, Мельниченко Галина

doi:10.15690/vramn1181

Cited by 3 publications

(1 citation statement)

References 71 publications

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“…Индекс пролиферации Ki-67 является прогностическим маркером эффективности лечения акромегалии, однако оценку данного показателя можно провести только после хирургического вмешательства. Полиморфизмы гена ИФР-1 и рецептора гормона роста относятся к генетическим предикторам эффективности оперативного лечения [ 3 ][ 4 ].…”

Section: обоснованиеunclassified

Short-term and long-term remission after endoscopic transnasal adenomectomy in patients with acromegaly

Lutsenko

Belaya

Przhiyalkovskaya

et al. 2022

Probl Endokrinol (Mosk)

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BACKGROUND. Neurosurgery is the most effective treatment for acromegaly. As most of the patients present with macroadenomas, surgical treatment is not always successful, even with the expert level of a neurosurgeon. Assessment of the postoperative remission rates in acromegaly preoperative predictors of treatment efficacy is an urgent task of modern research. AIM: To assess the short-term and long-term remission of acromegaly after endoscopic transnasal adenomectomy in a tertiary medical center and assess preoperative predictors of the treatment effectiveness.MATERIALS AND METHODS: A single-center, prospective, uncontrolled study was conducted. We included patients with active acromegaly who did not receive medical therapy with somatostatin analogues and were referred for endoscopic transsphenoidal adenomectomy. Plasma miRNA expression was assessed by quantitative reverse transcription PCR. Postoperative samples of adenomas were sent for study, with the determination of the immunohistochemical staining for somatostatin receptors 2 and 5 subtypes and morphology was performed on postoperative adenoma samples.RESULTS: The study included 44 patients: 32.8% men, median age 47.0 [34.0; 55.0], IGF-1 744.75 ng/ml [548.83;889.85], growth hormone 9.5 ng/ml [4.94; 17.07]. Tumor volume 832 mm3 [419.25; 2532.38]. Early postoperative remission was achieved in 35 patients (79.5%). Patients who achieved short-term remission had higher IGF-1 and basal growth hormone levels. Median follow-up was 19.0 months [12.5;29.0]. Long-term remission was achieved in 61.4% (27 patients), no remission in 9 (20.5%), recurrency in 2 patients (4.5%), 6 patients were to follow-up (13.6%). In patients with long-term remission, we observed lower growth hormone and IGF-1 levels. No differences in miRNA expression was observesd. The predictive value of basal GH before surgery for long-term remission was assessed: area under the curve 0.811 (95% CI: 0.649; 0.973). A cut-off value of 15.55 ng/mL corresponded to a sensitivity of 70.0% (34.8%; 93.3%), a specificity of 85.7% (67.3%; 96.0%), an accuracy of 81.6% (65 .7%; 92.3%), PPV 63.6% (39.3%; 82.5%), NPV 88.9% (75.4%; 95.4%).CONCLUSION: Rates of short-term and long-term remission after endoscopic transsphenoidal adenomectomy in our cohort is 79,5% и 61,4%, respectively, and is comparable with literature data for expert pituitary centers. Preoperative GH shows potential value in predicting the long-term remission of acromegaly, but further studies in a larger sample are needed to obtain more accurate cut-off values.

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Section: обоснованиеunclassified

Short-term and long-term remission after endoscopic transnasal adenomectomy in patients with acromegaly

Lutsenko

Belaya

Przhiyalkovskaya

et al. 2022

Probl Endokrinol (Mosk)

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Resistance to drug treatment of acromegaly and ways to overcome it

Golounina

Dzeranova²,

Pigarova³

et al. 2021

Obes. metabol.

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Acromegaly is a severe disabling neuroendocrine disease caused by hypersecretion of growth hormone (GH) and insulin-like growth factor 1 (IGF-1). The problem of resistance to drug therapy in patients with acromegaly is quite common in clinical practice and requires a personalized approach, considering various predictors of sensitivity to the choice of the treatment method. To date, first-generation somatostatin analogues are first-line drugs in the medical treatment of acromegaly, but up to 50% of patients do not achieve biochemical remission of the disease. The prognosis of sensitivity to somatostatin analogues is of great importance and the selection of patients in whom this therapy will be not successful provides invaluable assistance in choosing the optimal treatment approach. This review summarizes potential predictors of sensitivity and resistance to existing drug treatment of acromegaly, discusses possible ways to overcome the resulting resistance to therapy, suggests options for a personalized approach to choosing a treatment strategy in the absence of disease control against the background of monotherapy with somatostatin analogues, including «off-label» combinations. Timely addition of growth hormone receptor antagonist (pegvisomant) avoids repeated neurosurgical intervention, radiation therapy or prescribing excessively high doses of somatostatin analogues. Optimal use of mono- or combination therapy contributes to the achievement of biochemical remission in most resistant patients.

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Discordant parameters of insulin-like growth factor 1 and growth hormone in the diagnosis and monitoring of acromegaly

Sakhnova

Przhiyalkovskaya

Belaya

et al. 2021

Probl Endokrinol (Mosk)

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Acromegaly is a rare endocrine disorder associated with multiple complications and increased mortality. Timely diagnosis and adequate treatment can bring the life expectancy of patients with acromegaly closer to the general population level. The tests for the diagnosis of acromegaly are measurement of both serum GH, and GH after oral glucose administration; serum insulin-like growth factor-1 (IGF-1). However, in clinical practice, up to 39% of patients with discordant results are found. The patients with discordant GH and IGF-1levels, are the most difficult to manage. This review discusses the prevalence of discordant GH and IGF-1 outcomes in patients with acromegaly; factors causing this discrepancy; the impact of hormone levels on treatment outcomes. Although endocrinologists are used to dealing with this discrepancy in clinical practice for many years, discordant patients’outcome remains uncertain and undefined The optimal treatment should be individually tailored for each patient, taking into account all clinical parameters.

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Predictive biomarkers in the treatment of acromegaly: a review of the literature

Cited by 3 publications

References 71 publications

Short-term and long-term remission after endoscopic transnasal adenomectomy in patients with acromegaly

Short-term and long-term remission after endoscopic transnasal adenomectomy in patients with acromegaly

Resistance to drug treatment of acromegaly and ways to overcome it

Discordant parameters of insulin-like growth factor 1 and growth hormone in the diagnosis and monitoring of acromegaly

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