Changes in the management and comorbidities of acromegaly over three decades: the French Acromegaly Registry

Maione, Luigi; Brue, Thierry; Beckers, Albert; Delemer, Brigitte; Pétrossians, Patrick; Borson‐Chazot, Françoise; Chabre, Olivier; François, P.; Bertherat, Jérôme; Cortet‐Rudelli, Christine; Chanson, Philippe

doi:10.1530/eje-16-1064

Cited by 148 publications

(177 citation statements)

References 45 publications

(68 reference statements)

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“…In addition, patients followed up in the long term show a shift away from cardiovascular disease to cancer as a leading cause of death 25,88,89 (LQ). A continuum of benefit results from normalizing GH and IGF1 levels, leading to improved outcomes of disease-related comorbidities and reduced mortality risk 25 .…”

Section: Mortalitymentioning

confidence: 99%

A Consensus Statement on acromegaly therapeutic outcomes

et al. 2018

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Section: Mortalitymentioning

confidence: 99%

A Consensus Statement on acromegaly therapeutic outcomes

et al. 2018

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“…An improved disease control and a reduction of the proportion of patients with medically uncontrolled disease over time were also observed in the French Registry of Acromegaly (18). Registry data indicate that the proportion of patients who underwent radiotherapy as a second-line therapy decreased gradually over time, being replaced by medical therapy.…”

Section: Outcome Of Multimodal Treatmentmentioning

confidence: 69%

“…Of interest, in a modern Danish cohort, overall mortality risk was still increased, but only with about 30% compared to the background population, again primarily due to an increased cardiovascular mortality (17). Conversely, in the French Registry of Acromegaly, life expectancy was close to the general population, SMR 1.05 (95% CI: 0.70-1.42), and cancer occurred just in 10% of patients, but most deaths were related to malignancies (18). Lastly, a recent systematic review and meta-analysis, showed that mortality was increased in the studies published before 2008, but did not differ from the general population (SMR: 1.35 (95% CI: 0.99-1.85)) in studies published after 2008.…”

Section: Epidemiologymentioning

confidence: 96%

“…As this registry only spans less than a decade, no change in primary strategy over time was presented (29). The French Registry also published recently in this journal (18), described in principle the same changes in treatment pattern over time. A total of 1034 patients were included, women being significantly older than men (median age 49 vs 43 years).…”

Section: Changing Strategiesmentioning

confidence: 97%

“…The authors stress that 63% of the patients receiving primary medical therapy underwent a subsequent neurosurgical procedure. Of interest, the use of first-line medical treatment was not associated with the size but with lateral extension of the tumour (18).…”

Section: Changing Strategiesmentioning

confidence: 99%

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MANAGEMENT OF ENDOCRINE DISEASE: Individualised management of acromegaly

Bollerslev

Heck

Olarescu

2019

European Journal of Endocrinology

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Acromegaly is a rare and challenging disease calling for management in highly specialised multidisciplinary teams (MDTs). Untreated disease has severe morbidity and a clearly increased mortality. Major attainments have been gained over the latest decades, and therefore, the aim of this review is to discuss recent achievements in modern multimodal therapy of acromegaly performed by MDTs, with an emphasis on an individualised, proactive management from the time of diagnosis to long-term outcome. Treatment by surgery is the only potential curative treatment, however, even with modern techniques still with modest cure rates, leaving the patients to often long-term medical treatment. Treatment strategies have changed dramatically in the Western world over recent years, implying a more proactive treatment algorithm often with a shorter or longer pre-surgical treatment period with somatostatin receptor ligands (SRLs). Not all patients will however respond to primary treatment with conventional SRLs and there has recently been a development of potential biomarkers for response that has been implemented in the clinical routine. By today, multimodal treatment can bring every patient in remission, but still almost a third of all patients are undertreated according to large, international registries. On the other hand, it might be a challenge not to over treat thereby bringing the patient into a state of relative or absolute growth hormone deficiency. Clinical series published during the last decade on treatment of patients with acromegaly have indicated a normalisation of mortality, most probably reflecting the proactive and individualised modern treatment. In conclusion, modern, multimodal treatment seems to have normalised mortality, but still the patients suffer from a high multi-organ morbidity and often multipharmacy. Every patient should receive an individualised, proactive treatment in order to improve long-term outcome and to reduce costs for the society.Correspondence should be addressed to J Bollerslev . His special interest is within clinical and translational endocrinology, and in particular, in classical endocrine diseases, such as acromegaly and Cushing's, often studying bone as target tissues for clinical activity. A major topic has been clinical management of acromegaly, and especially searching for biomarkers for responsiveness to medical therapy. Prospectively collected data of newly diagnosed patients with acromegaly has been the background for current studies of individualised, multimodal and transdisciplinary treatment. European Journal of Endocrinology 181:2 R60 Review J Bollerslev and others Managing acromegaly https://eje.bioscientifica.com European Journal of Endocrinology 181:2 R61 Review J Bollerslev and others Managing acromegaly https://eje.bioscientifica.com European Journal of Endocrinology 181:2 R63 Review J Bollerslev and others Managing acromegaly https://eje.bioscientifica.com European Journal of Endocrinology 181:2 R64 Review J Bollerslev and others Managing acromegaly https://eje.bioscie...

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Hypertension in Acromegaly

Kamenický

Chanson

2020

Updates in Hypertension and Cardiovascular Protection

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Changes in the management and comorbidities of acromegaly over three decades: the French Acromegaly Registry

Cited by 148 publications

References 45 publications

A Consensus Statement on acromegaly therapeutic outcomes

A Consensus Statement on acromegaly therapeutic outcomes

MANAGEMENT OF ENDOCRINE DISEASE: Individualised management of acromegaly

Hypertension in Acromegaly

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