A Comprehensive Study of Clinical, Biochemical, Radiological, Vascular, Cardiac, and Sleep Parameters in an Unselected Cohort of Patients With Acromegaly Undergoing Presurgical Somatostatin Receptor Ligand Therapy

Annamalai, Anand K; Webb, Alison; Kandasamy, Narayanan; Elkhawad, Maysoon; Moir, Samantha; Khan, Fakhar Z.; Mäki-Petäjä, Kaisa; Gayton, Emma L.; Strey, C; O'Toole, Samuel; Ariyaratnam, Shaumya; Halsall, David; Chaudhry, Afzal; Berman, Laurence; Scoffings, Daniel; Antoun, Nagui M.; Dutka, David P.; Wilkinson, Ian B.; Shneerson, John M.; Pickard, John D.; Simpson, Helen; Gurnell, Mark

doi:10.1210/jc.2012-3072

Cited by 125 publications

(109 citation statements)

References 56 publications

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“…Pharmacological treatment of acromegaly improves left ventricular hypertrophy and dysfunction (HQ), hypertension (LQ), and obstructive sleep apnoea (MQ). [40][41][42][43][44] However, pharmacological treatment of acromegaly might not improve arthropathy (LQ), and effects on soft-tissue tumours are unknown. New techniques are needed to measure bone and joint integrity to assess better the effects of acromegaly treatment (MQ).…”

Section: Comorbiditiesmentioning

confidence: 99%

“…SRLs are the primary medical treatment option if surgery is not appropriate (for example, in patients with medical contraindications such as recent myocardial infarction; if surgery is delayed; or when the patient refuses the surgical option) (SR). 42,[58][59][60] For macroadenomas, pre-surgical SRL treatment might improve outcomes, but prospective data are limited with regards to the benefit or harm of this treatment option (LQ). 61 When assessing postsurgical hormone-related outcomes in patients receiving pre-surgical SRL treatment, the drug carry-over effect Figure 1 | Medical management of patients with acromegaly.…”

Section: Primary Treatmentmentioning

confidence: 99%

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Expert consensus document: A consensus on the medical treatment of acromegaly

et al. 2014

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| In March 2013, the Acromegaly Consensus Group met to revise and update guidelines for the medical treatment of acromegaly. The meeting comprised experts skilled in the medical management of acromegaly. The group considered treatment goals covering biochemical, clinical and tumour volume outcomes, and the place in guidelines of somatostatin receptor ligands, growth hormone receptor antagonists and dopamine agonists, and alternative modalities for treatment including combination therapy and novel treatments. This document represents the conclusions of the workshop consensus.

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Section: Comorbiditiesmentioning

confidence: 99%

Section: Primary Treatmentmentioning

confidence: 99%

Expert consensus document: A consensus on the medical treatment of acromegaly

et al. 2014

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“…Therefore, according to the recommendations of the Polish Society of Endocrinology, one should consider the need for the pre-surgical use of long-acting somatostatin analogues which facilitate surgical treatment by reducing the volume and changing the consistency of the pituitary tumour as well as by ensuring the clinical improvement of patients [15]. This treatment results in reduced swelling of soft tissues (easier intubation), and improved cardiovascular functions (decreased blood pressure and reduced degree of heart failure), obstructive sleep apnoea and parameters of metabolic disorders [16]. Better outcomes of surgical treatment are achieved in centres where an experienced neurosurgeon performs at least 50 transsphenoidal surgeries a year [13,17].…”

Section: Disease Managementmentioning

confidence: 99%

Akromegalia — nowe spojrzenie na pacjenta. Polskie propozycje postępowania diagnostyczno-terapeutycznego w akromegalii w świetle aktualnych doniesień

Bolanowski¹,

Ruchała²,

Zgliczyński³

et al. 2014

Endokrynologia Polska

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Acromegaly is a rare disease caused by the secretion of growth hormone (GH) in excess, in most cases from a pituitary tumour. The diagnosis is usually delayed and is often associated with the development of various complications causing premature mortality. In patients with hypertension, heart failure, diabetes, and arthropathy that is non-specific for age, attention should be paid to the occurrence of somatic signs of acromegaly. As a screening test, insulin-like growth factor-1 (IGF-1) concentration should be assessed. Further diagnostic and treatment procedures are possible in specialised centres. The first-line therapy is selective transsphenoidal adenomectomy. Patients with a good prognosis related to a surgical removal of the pituitary tumour should be referred only to centres experienced in performing this type of procedure, after pharmacological preparation. Other patients, and those who have not recovered after surgical treatment, should be subjected to long-term pharmacotherapy with long-acting somatostatin analogues. In each case, the complications of acromegaly should be followed-up long-term and actively treated. This proposed new recommendation should be helpful for the management of patients with acromegaly. (Endokrynol Pol 2014; 65 (4): 326-331) Key words: acromegaly; diagnosis; therapy; guidelines StreszczenieAkromegalia jest rzadką chorobą spowodowaną nadmiernym wydzielaniem hormonu wzrostu (GH), zwykle przez guz przysadki. Rozpoznanie jest opóźnione i często związane z rozwojem różnych powikłań powodujących zwiększone zagrożenie zgonem. U chorych z nadciśnieniem, niewydolnością serca, cukrzycą, artropatiami, nietypowymi do wieku należy zwrócić uwagę na występowanie objawów akromegalii. Jako badanie przesiewowe należy wykonać oznaczenie stężenia insulinopodobnego czynnika wzrostu-1 (IGF-1). Dalsza diagnostyka i leczenie powinny być prowadzone w wyspecjalizowanych ośrodkach. Leczeniem pierwszego rzutu jest wybiórcze usunięcie gruczolaka przysadki z dostępu przez zatokę klinową. Pacjenci rokujący wyleczenie operacyjnym usunięciem guza przysadki powinni być kierowani do ośrodków z doświadczeniem w tego typu zabiegach, po przygotowaniu farmakologicznym. Pozostali chorzy oraz ci po nieskutecznym leczeniu neurochirurgicznym powinni być długotrwale leczeni analogami somatostatyny. W każdym przypadku następ-stwa akromegalii winny być przez całe życie monitorowane i aktywnie leczone. Proponowane nowe zalecenia powinny być pomocne w postępowaniu z pacjentami chorymi na akromegalię. (Endokrynol Pol 2014; 65 (4): 326-331)

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“…Somatostatin analogues are considered the first option of medical treatment in the majority of patients, but prospective randomized studies show control rates of 20-40% for patients with first-generation SA (4,(7)(8)(9)(10)(11). Pasireotide LAR, a next-generation SA (not yet approved for acromegaly treatment in Brazil), allows disease control in a higher percentage of patients and is effective in approximately 15% of those patients not controlled by first-generation SA with the dose of 40 mg and in 20% of the patients with the dose of 60 mg (12,13).…”

Section: Introductionmentioning

confidence: 99%

Experience with pegvisomant treatment in acromegaly in a single Brazilian tertiary reference center: efficacy, safety and predictors of response

Kasuki

Machado

Ogino

et al. 2016

Arch. Endocrinol. Metab.

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Objective: To describe the safety and efficacy of pegvisomant therapy and the predictors of treatment response in acromegaly patients at a single tertiary reference center in Brazil. Materials and methods: We retrospectively reviewed the clinical, hormonal and radiological data of acromegaly patients treated with pegvisomant in our center. We also evaluated the presence of the d3 isoform of the growth hormone receptor (d3GHR). Results: Twenty-seven patients were included (17 women). Pegvisomant was used in combination with octreotide LAR in 20 patients (74%), in combination with cabergoline in one (4%) and as monotherapy in six (22%). IGF-I normalization was achieved in 23 patients (85%). Mild and transitory elevation of liver enzymes was observed in two patients (7.4%), tumor growth in one (3.4%) and lipodystrophy in two (7.4%). One patient stopped the drug due to headaches. The GHR isoforms were evaluated in 14 patients, and the presence of at least one d3GHR allele was observed in 43% of them, but it was not a predictor of treatment response. Only pretreatment IGF-I level was a predictor of treatment response. Conclusion: Pegvisomant treatment was highly effective and safe in our series of Brazilian patients. A better chance of disease control can be expected in those with lower pre-pegvisomant IGF-I levels. Arch Endocrinol Metab. 2016;60(5):479-85

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A Comprehensive Study of Clinical, Biochemical, Radiological, Vascular, Cardiac, and Sleep Parameters in an Unselected Cohort of Patients With Acromegaly Undergoing Presurgical Somatostatin Receptor Ligand Therapy

Cited by 125 publications

References 56 publications

Expert consensus document: A consensus on the medical treatment of acromegaly

Expert consensus document: A consensus on the medical treatment of acromegaly

Akromegalia — nowe spojrzenie na pacjenta. Polskie propozycje postępowania diagnostyczno-terapeutycznego w akromegalii w świetle aktualnych doniesień

Experience with pegvisomant treatment in acromegaly in a single Brazilian tertiary reference center: efficacy, safety and predictors of response

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