Preoperative medical treatments and surgical approaches for acromegaly: A systematic review

Papaioannou, Christos; Druce, Maralyn

doi:10.1111/cen.14790

Cited by 2 publications

(1 citation statement)

References 58 publications

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“…This treatment has been tested in five randomized clinical trials [24][25][26][27][28] and subjected to several meta-analyses. [29][30][31][32] Current consensus statements only recommend preoperative SSA treatment in individual cases where the likelihood of surgical cure is considered low. 4,17,33 Consensus was not reached regarding the management of asymptomatic patients with marginally elevated GH/IGF-I postsurgery in the absence of a significant tumor remnant or disease-specific comorbidity.…”

Section: Discussionmentioning

confidence: 99%

Acromegaly management in the Nordic countries: A Delphi consensus survey

Arlien‐Søborg,

Dal,

Heck

et al. 2024

Clinical Endocrinology

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ObjectiveAcromegaly is associated with increased morbidity and mortality if left untreated. The therapeutic options include surgery, medical treatment, and radiotherapy. Several guidelines and recommendations on treatment algorithms and follow‐up exist. However, not all recommendations are strictly evidence‐based. To evaluate consensus on the treatment and follow‐up of patients with acromegaly in the Nordic countries.MethodsA Delphi process was used to map the landscape of acromegaly management in Denmark, Sweden, Norway, Finland, and Iceland. An expert panel developed 37 statements on the treatment and follow‐up of patients with acromegaly. Dedicated endocrinologists (n = 47) from the Nordic countries were invited to rate their extent of agreement with the statements, using a Likert‐type scale (1−7). Consensus was defined as ≥80% of panelists rating their agreement as ≥5 or ≤3 on the Likert‐type scale.ResultsConsensus was reached in 41% (15/37) of the statements. Panelists agreed that pituitary surgery remains first line treatment. There was general agreement to recommend first‐generation somatostatin analog (SSA) treatment after failed surgery and to consider repeat surgery. In addition, there was agreement to recommend combination therapy with first‐generation SSA and pegvisomant as second‐ or third‐line treatment. In more than 50% of the statements, consensus was not achieved. Considerable disagreement existed regarding pegvisomant monotherapy, and treatment with pasireotide and dopamine agonists.ConclusionThis consensus exploration study on the management of patients with acromegaly in the Nordic countries revealed a relatively large degree of disagreement among experts, which mirrors the complexity of the disease and the shortage of evidence‐based data.

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