A Consensus Statement on acromegaly therapeutic outcomes

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Abstract

The 11th Acromegaly Consensus Conference in April 2017 was convened to update recommendations on therapeutic outcomes for patients with acromegaly. Consensus guidelines on the medical management of acromegaly were last published in 2014; since then, new pharmacological agents have been developed and new approaches to treatment sequencing have been considered. Thirty-seven experts in the management of patients with acromegaly reviewed the current literature and assessed changes in drug approvals, clinical practice standards and clinical opinion. They considered current treatment outcome goals with a focus on the impact of current and emerging somatostatin receptor ligands, growth hormone receptor antagonists and dopamine agonists on biochemical, clinical, tumour mass and surgical outcomes. The participants discussed factors that would determine pharmacological choices as well as the proposed place of each agent in the guidelines. We present consensus recommendations highlighting how acromegaly management could be optimized in clinical practice.

Abstract

Acromegaly is usually caused by a pituitary adenoma that secretes growth hormone; treatment of acromegaly and its comorbidities is often complex. In this Consensus Statement, Shlomo Melmed and colleagues provide updated recommendations for the treatment of patients with acromegaly.

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Most cited references 123

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Acromegaly: an endocrine society clinical practice guideline.

Laurence Katznelson, Edward Laws, Shlomo Melmed … (2014)

The aim was to formulate clinical practice guidelines for acromegaly.

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Systemic complications of acromegaly: epidemiology, pathogenesis, and management.

Annamaria Colao, Diego Ferone, Paolo Marzullo … (2004)

This review focuses on the systemic complications of acromegaly. Mortality in this disease is increased mostly because of cardiovascular and respiratory diseases, although currently neoplastic complications have been questioned as a relevant cause of increased risk of death. Biventricular hypertrophy, occurring independently of hypertension and metabolic complications, is the most frequent cardiac complication. Diastolic and systolic dysfunction develops along with disease duration; and other cardiac disorders, such as arrhythmias, valve disease, hypertension, atherosclerosis, and endothelial dysfunction, are also common in acromegaly. Control of acromegaly by surgery or pharmacotherapy, especially somatostatin analogs, improves cardiovascular morbidity. Respiratory disorders, sleep apnea, and ventilatory dysfunction are also important contributors in increasing mortality and are advantageously benefitted by controlling GH and IGF-I hypersecretion. An increased risk of colonic polyps, which more frequently recur in patients not controlled after treatment, has been reported by several independent investigations, although malignancies in other organs have also been described, but less convincingly than at the gastrointestinal level. Finally, the most important cause of morbidity and functional disability of the disease is arthropathy, which can be reversed at an initial stage, but not if the disease is left untreated for several years.

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Author and article information

Contributors

Shlomo Melmed: melmed@csmc.edu

Journal

Journal ID (nlm-ta): Nat Rev Endocrinol

Journal ID (iso-abbrev): Nat Rev Endocrinol

Title: Nature Reviews. Endocrinology

Publisher: Nature Publishing Group UK (London )

ISSN (Print): 1759-5029

ISSN (Electronic): 1759-5037

Publication date (Electronic): 26 July 2018

Publication date PMC-release: 26 July 2018

Publication date (Print): 2018

Volume: 14

Issue: 9

Pages: 552-561

Affiliations

[1 ]ISNI 0000 0001 2152 9905, GRID grid.50956.3f, Department of Medicine, , Cedars-Sinai Medical Center, ; Los Angeles, CA USA

[2 ]ISNI 0000 0004 1937 0722, GRID grid.11899.38, Division of Endocrinology and Metabolism, Hospital das Clinicas, , University of São Paulo, ; São Paulo, Brazil

[3 ]ISNI 0000 0001 2181 7253, GRID grid.413784.d, Assistance Publique-Hôpitaux de Paris, Service d’Endocrinologie et des Maladies de la Reproduction, Centre de Référence des Maladies Rares de l’Hypophyse, , Hôpital Bicêtre, ; Paris, France

[4 ]ISNI 0000 0001 2171 2558, GRID grid.5842.b, UMR S-1185, Faculté de Médecine Paris-Sud, , Université Paris-Sud, Université Paris-Saclay, ; Paris, France

[5 ]ISNI 0000 0004 0386 9924, GRID grid.32224.35, Department of Medicine, , Massachusetts General Hospital, ; Boston, MA USA

[6 ]ISNI 0000000109410645, GRID grid.11794.3a, Department of Medicine, , Santiago de Compostela University, ; Santiago de Compostela, Spain

[7 ]ISNI 0000 0004 0488 9484, GRID grid.415719.f, Department of Endocrinology, , Churchill Hospital, ; Oxford, UK

[8 ]ISNI 0000 0001 2218 4662, GRID grid.6363.0, Department of Medicine, , Charité Universitätsmedizin Campus Mitte, ; Berlin, Germany

[9 ]ISNI 0000 0000 9259 8492, GRID grid.22937.3d, Division of Endocrinology and Metabolism, , Medical University of Vienna, ; Vienna, Austria

[10 ]ISNI 0000 0001 1034 1720, GRID grid.410711.2, Department of Medicine, , University of North Carolina, ; Chapel Hill, NC USA

[11 ]ISNI 0000000417581884, GRID grid.18887.3e, Department of Endocrinology and Metabolism, , San Raffaele University Hospital Milan, ; Milan, Italy

Article

Publisher ID: 58

DOI: 10.1038/s41574-018-0058-5

PMC ID: 7136157

PubMed ID: 30050156

SO-VID: 78587026-98a3-4e00-95e8-bf795e6ad173

License:

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.