Decreasing mortality and changes in treatment patterns in patients with acromegaly from a nationwide study

Espósito, Daniela; Ragnarsson, Oskar; Granfeldt, Daniel; Marlow, Thomas; Johannsson, Gudmundur; Olsson, Daniel S

doi:10.1530/eje-18-0015

Cited by 81 publications

(71 citation statements)

References 37 publications

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“…The study described a more active surgical approach over the time period, increasing from 58% in patients diagnosed in the period before 1995 to 72% after 2005 (P < 0.001), with no change in the proportion of patients undergoing radiotherapy (from10 to 15%, P = 0.12). Most importantly, the proportion of patients developing hypopituitarism decreased significantly over the period (from 41 to 23%, P < 0.001), ascribed as the most important factor for the improved patients prognosis (13).…”

Section: Changing Strategiesmentioning

confidence: 93%

“…Acromegaly has an estimated prevalence of 28-137 cases/ million inhabitants and the incidence vary between 2 and 11 cases/million per year (13,14). The clinical manifestations of acromegaly are broadly divided in signs and symptoms caused by the local tumour extension (headache, visual-field defects, cranial-nerve palsy and hypopituitarism) and systemic manifestations related to the prolonged exposure to GH/IGF-I excess.…”

Section: Epidemiologymentioning

confidence: 99%

“…The most recent study on acromegaly from the Swedish Pituitary Registry found an overall standard mortality rate (SMR) of 1.33 (95% CI: 1.17-1.52). However, the mortality was only increased during the first time period (1987)(1988)(1989)(1990)(1991)(1992)(1993)(1994)(1995) suggesting a decrease of mortality over time (13) (Erratum published in January 2019 https://doi.org/10.1530/EJE-18-0015e). 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).…”

Section: Epidemiologymentioning

confidence: 99%

“…The most recent registry, from Sweden, described 1089 patients diagnosed between 1987 and 2013 (13). The distribution between micro-and macroadenomas was not given, and medical treatment pattern was only available for a subgroup of 338 patients diagnosed after 2005.…”

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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Section: Changing Strategiesmentioning

confidence: 93%

Section: Epidemiologymentioning

confidence: 99%

Section: Epidemiologymentioning

confidence: 99%

Section: Changing Strategiesmentioning

confidence: 99%

See 2 more Smart Citations

MANAGEMENT OF ENDOCRINE DISEASE: Individualised management of acromegaly

Bollerslev

Heck

Olarescu

2019

European Journal of Endocrinology

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“…The prevalence of acromegaly in Europe is estimated to 28-137 cases per million, and the estimation of annual incidence varies from 2 to 11 patients per million. 3,4 Due to its slow onset and insidious progression, acromegaly often remains long unrecognized in spite of presence of signs and symptoms. Time from first symptoms to diagnosis is estimated as 5-10 years.…”

Section: Introductionmentioning

confidence: 99%

The place of medical treatment of acromegaly in Serbia: Current status

Doknic

Stojanović

2021

VOJNOSANIT PREGL

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The past two decades have brought significant advancement in treatment of acromegaly, primarily due to discovery of new medications and broadening of their availability. Accordingly, mortality rate of patients with acromegaly has decreased significantly and in adequately treated patients it approximates the general population. Treatment of acromegaly requires a combination of several modalities: neurosurgical operation, medical treatment and radiotherapy. Treatment of acromegaly in Serbia is conducted in accordance to international guidelines and recommendations. Recent availability of novel medical therapies for acromegaly in Serbia, demanded a need for creation of recommendations for optimal application of these new treatment options. Medical treatment of acromegaly encompasses three groups of drugs: 1) somatostatin receptor ligands, 2) dopamine agonists, 3) GH receptor antagonists. Every patient requires individual approach in treatment selection, usually involving a combination of multiple treatment modalities. Considerable cost of some medications, even in the economically developed countries, poses an additional challenge for the endocrinologist responsible for selection of treatment. Individualized approach to treatment ensures better disease control, reduction or elimination of comorbidities and reduction in cost of treatment of this chronic disease.

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Hypertension in Acromegaly

Kamenický

Chanson

2020

Updates in Hypertension and Cardiovascular Protection

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Decreasing mortality and changes in treatment patterns in patients with acromegaly from a nationwide study

Cited by 81 publications

References 37 publications

MANAGEMENT OF ENDOCRINE DISEASE: Individualised management of acromegaly

MANAGEMENT OF ENDOCRINE DISEASE: Individualised management of acromegaly

The place of medical treatment of acromegaly in Serbia: Current status

Hypertension in Acromegaly

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