A Comprehensive Review of Four Clinical Practice Guidelines of Acromegaly

Abstract

Acromegaly is an endocrine disorder characterized by dysregulated hypersecretion of growth hormone (GH), leading to an overproduction of insulin-like growth factor 1 (IGF-1). The etiology is usually a GH-secreting pituitary adenoma with the resultant presentation of coarse facial features, frontal bossing, arthritis, prognathism (protrusion of the mandible), and impaired glucose tolerance, among others. Most pituitary adenomas arise due to sporadic mutations that lead to unregulated cellular division, subsequent tumor formation, and resultant GH hypersecretion. Major scientific organizations and authorities in endocrinology release regularly updated guidelines for diagnosing and managing acromegaly. We have holistically evaluated four data-driven and evidentiary approaches in the management of acromegaly to compare and contrast these guidelines and show their salient differences. These guidelines have been reviewed because they are major authorities in acromegaly management. In this comprehensive article, differences in the diagnosis and treatment recommendations of the discussed guidelines have been highlighted. Our findings showed that diagnosing modalities were similar among the four approaches; however, some guidelines were more specific about additional supporting investigations to confirm a diagnosis of acromegaly. For management options, each guideline had suggestions about ideal therapeutic outcomes. Treatment options were identical but salient differences were noticed, such as the addition of combination therapy and alternative therapy in the setting of failure to respond to first and second-line treatments. Reviewing clinical guidelines for various pathologies encourages sharing ideas among medical practitioners and ensures that global best practices are adopted. Therefore, a constant review of these clinical practice guidelines is necessary to keep clinicians up to date with the latest trends in patient management.

Approach of Acromegaly during Pregnancy

“…A coordinated team of different specialists is required to treat the associated complications in addition to the targeted approach of the pituitary tumor; this mostly involves selective trans-sphenoidal hypohysectomy as the first line of therapy to address somatotropinoma expansion and GH-IGF1 excess and/or pharmaco-treatment underlying two generations of somatostatin analogues (SSAs)—octreotide, lanreotide, respective pasireotide, dopamine analogues (DAs)—bromocriptine and cabergoline, and GH receptors antagonist—pegvisomant, as well as radiotherapy, especially gamma knife type, in selected cases [ 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 ]. These aspects are detailed in numerous guidelines from different endocrine, surgery and multidisciplinary societies [ 15 , 16 , 17 , 18 , 19 , 23 ]. General increased life expectancy and advanced progress of acromegaly management associate not only a higher number of patients with somatotropinomas among an elderly population and a younger age group at first detection, but also a larger number of women of reproductive age that are potentially able to carry a child and deliver a healthy new-born [ 24 , 25 , 26 , 27 , 28 , 29 ].…”

Recognizing the Diverse Clinical Presentations of Acromegaly: Insight from a Case Series

“…Sweating is also a common symptom at presentation. 13,15 Three of the four cases had headaches and one had sweating at presentation. Both diabetes mellitus and hypertension are prevalent among acromegaly patients.…”

“…The diagnosis of acromegaly may be delayed up to many years due to the slow and delayed development of clinical features. 13 Moreover, diabetes and hypertension and their related health problems are common among these patients which may obscure it from the attention of the healthcare professionals. This delay causes late surgical intervention and thus, can impart unfavorable effects on prognosis.…”

Transsphenoidal hypophysectomy for the treatment of hypersomatotropism secondary to a pituitary somatotroph adenoma in a dog

“…As a result, surgical treatment by transsphenoidal hypophysectomy was effective in achieving remission of acromegaly in this dog and can be considered as a first‐line treatment for dogs with pituitary adenoma‐associated growth hormone excess. While there is evidence of treatment benefit associated with medical management, 23 , 24 , 25 , 26 , 27 transsphenoidal hypophysectomy provides the additional potential for a curative treatment by removing the hormone‐producing pituitary tumor.…”