A Consensus on the Diagnosis and Treatment of Acromegaly Comorbidities: An Update

Abstract

Objective The aim of the Acromegaly Consensus Group was to revise and update the consensus on diagnosis and treatment of acromegaly comorbidities last published in 2013. Participants The Consensus Group, convened by 11 Steering Committee members, consisted of 45 experts in the medical and surgical management of acromegaly. The authors received no corporate funding or remuneration. Evidence This evidence-based consensus was developed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system to describe both the strength of recommendations and the quality of evidence following critical discussion of the current literature on the diagnosis and treatment of acromegaly comorbidities. Consensus Process Acromegaly Consensus Group participants conducted comprehensive literature searches for English-language papers on selected topics, reviewed brief presentations on each topic, and discussed current practice and recommendations in breakout groups. Consensus recommendations were developed based on all presentations and discussions. Members of the Scientific Committee graded the quality of the supporting evidence and the consensus recommendations using the GRADE system. Conclusions Evidence-based approach consensus recommendations address important clinical issues regarding multidisciplinary management of acromegaly-related cardiovascular, endocrine, metabolic, and oncologic comorbidities, sleep apnea, and bone and joint disorders and their sequelae, as well as their effects on quality of life and mortality.

Bone densitometry by radiofrequency echographic multi-spectrometry (REMS) in acromegaly patients

“…Acromegaly is a rare disease characterised by elevated levels of growth hormone (GH) and insulin-like growth factor I (IGF-I) mainly due to pituitary adenoma [1]. An excess amount of these hormones leads to a lot of systemic complications including secondary osteoporosis and vertebral fractures [2,3]. Growth hormone and IGF-I are anabolic hormones responsible for enhanced bone formation and achievement of peak bone mass.…”

An evaluation of the Acromegaly Treatment Satisfaction Questionnaire (Acro-TSQ) in adult patients with acromegaly, including correlations with other patient-reported outcome measures: data from two large multicenter international studies

“…AIS Overall Scores at screening were divided into three categories (Low = 0-3, Medium = 4-7, High ≥ 7), which resulted in relatively comparably sized groups. The cutoffs for IGF-1 were based upon clinical treatment guidelines [7,26] with the following cutoffs: ≤ 1.0 upper limits of normal (ULN) and > 1.0 ULN.…”

“…Patients can experience changes to their appearance and enlargement of hands and feet, as well as other symptoms and comorbidities [4]. First-line medical treatment is commonly somatostatin analogs (SSAs) [5][6][7] administered as either intramuscular (octreotide LAR) or deep subcutaneous injections (lanreotide depot); however, common side effects can include injection site reactions and gastrointestinal (GI) symptoms [8,9]. Despite achieving biomedical control as defined by normal IGF-1 and GH levels, acromegaly symptoms may persist [10].…”

Italian Association of Clinical Endocrinologists (AME) and Italian AACE Chapter Position Statement for Clinical Practice: Acromegaly - Part 1: Diagnostic and Clinical Issues

“…Early diagnosis, monitoring, and treatment of cardiovascular risk factors and diseases are mandatory [ 53 , 54 ].…”