Predictors of Quality of Life in 165 Patients With Acromegaly: Results from a Single-Center Study

Kreitschmann-Andermahr, Ilonka; Buchfelder, Michael; Kleist, Bernadette; Kohlmann, Johannes; Menzel, Christa; Buslei, Rolf; Kołtowska-Häggsträm, Maria; Strasburger, Christian J.; Siegel, Sonja

doi:10.4158/ep161373.or

Cited by 26 publications

(23 citation statements)

References 30 publications

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“…Acromegaly affects both males and females; many studies have demonstrated that females are more frequently affected, but some have indicated that both sexes are equally affected (9,14,15,17,18,21,22,(27)(28)(29). In the present study, females accounted for 58.8% of all patients, significantly larger than the percentage of males.…”

Section: Discussioncontrasting

confidence: 49%

“…GH over-secretion leads to increased serum insulin-like growth factor 1 (IGF-1), and both hormones result in a series of acromegaly-associated symptoms, i.e., facial appearance changes; overgrowth of hands and feet; headache; visual field defects; and comorbidities affecting the cardiovascular system, respiratory system, musculoskeletal organs, endocrine/metabolic system, etc (3-7). Since the above clinical features of acromegaly develop insidiously, the diagnosis of this condition is therefore often delayed, and prolonged diagnostic delays are associated with reduced quality of life (QoL) and elevated morbidity and mortality in patients with acromegaly (7)(8)(9). The main therapeutic goals include normalization of the circulating levels of GH and IGF-1, removal of pituitary tumors without damaging the adjacent structures, amelioration of symptoms and comorbidities, and restoration of normal life expectancy and QoL (3,4,10).…”

Section: Introductionmentioning

confidence: 99%

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Patient Characteristics, Diagnostic Delays, Treatment Patterns, Treatment Outcomes, Comorbidities, and Treatment Costs of Acromegaly in China: A Nationwide Study

Guo

Wang

et al. 2020

Front. Endocrinol.

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PurposeAcromegaly is a rare, intractable endocrine disease. We aimed to describe the patient characteristics, diagnostic delays, treatment patterns, treatment outcomes, comorbidities and treatment costs of acromegaly in China.MethodsThis is a nationwide cross-sectional study. Patients diagnosed with and treated for acromegaly between 1996 and 2019 across China were surveyed via the Chinese Association of Patients with Acromegaly platform.ResultsIn total, 473 patients (58.8% females, mean age at diagnosis: 39.4±9.5 years) were included. The median disease duration was 3 years. The most common symptoms were extremity enlargement (91.8%) and facial changes (90.1%). Overall, 63.0% of patients experienced diagnostic delays within healthcare systems; 63.8% of the delays were <1 year. The most common first-line therapy was surgery with a transsphenoidal (76.1%) or transcranial approach (3.2%). Somatostatin analogues or dopamine agonists were administered in 20.5% of the patients as first-line therapies and in 41.7% as adjuvant therapies. Radiotherapy was performed in 32.1% of patients, 99.3% of whom received radiotherapy as an adjuvant therapy. After a median 5-year follow-up, 46.2% achieved biochemical control. Comorbidities were reported in 88.2% of the patients at follow-up; memory deterioration and thyroid nodules were the most common. Controlled patients had greater improvements in symptoms and comorbidities during follow-up than uncontrolled patients. The annual per-capita cost-of-treatment was $11013 in 2018, with medical treatments being the largest contributor (67%). Medical insurance covered 47.2% of all treatment costs.ConclusionThis study provides the first comprehensive description of real-world acromegaly data in China, serving as a basis for future population-based studies.

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Section: Discussioncontrasting

confidence: 49%

Section: Introductionmentioning

confidence: 99%

Patient Characteristics, Diagnostic Delays, Treatment Patterns, Treatment Outcomes, Comorbidities, and Treatment Costs of Acromegaly in China: A Nationwide Study

Guo

Wang

et al. 2020

Front. Endocrinol.

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“…However, addressing the high discordance between patient-and medical provider-reported symptom severity, pattern of acromegaly symptoms, and treatment injection site reactions remains a challenge for treating physicians [12]. The relationship between sex and QOL remains unclear due to heterogeneous methods and design, assessment tools, and patient cohorts [36,37].…”

Section: What's Newmentioning

confidence: 99%

A Pituitary Society update to acromegaly management guidelines

et al. 2020

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Guidelines and consensus statements ensure that physicians managing acromegaly patients have access to current information on evidence-based treatments to optimize outcomes. Given significant novel recent advances in understanding acromegaly natural history and individualized therapies, the Pituitary Society invited acromegaly experts to critically review the current literature in the context of Endocrine Society guidelines and Acromegaly Consensus Group statements. This update focuses on how recent key advances affect treatment decision-making and outcomes, and also highlights the likely role of recently FDA-approved therapies as well as novel combination therapies within the treatment armamentarium.

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“…Quality of life in patients with acromegaly treated with stereotactic RT has not been studied. Recently, RT (of unknown type) was a predictor of poor mental QoL and depression, described in about one-third of 165 patients with acromegaly operated in a single center in Germany from 2000 to 2012 (98). An association of CRT with reduced QoL, even after disease remission, was also found in previous studies in acromegaly (33)(34)(35).…”

Section: Srs Side Effectsmentioning

confidence: 72%

Stereotactic Radiation Therapy in Pituitary Adenomas, is it Better than Conventional Radiation Therapy

Gheorghiu

Fleseriu

2017

Acta Endo (Buc)

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Pituitary radiotherapy (RT) has undergone important progress in the last decades due to the development of new stereotactic techniques which provide more precise tumour targeting with less overall radiation received by the adjacent brain structures. Pituitary surgery is usually firstline therapy in most patients with nonfunctioning (NFPA) and functioning adenomas (except for prolactinomas and large growth hormone (GH) secreting adenomas), while RT is used as second or third-line therapy. The benefits of RT (tumour volume control and, in functional tumours, decreased hormonal secretion) are hampered by the long latency of the effect and the potential side effects. This review presents the updates in the efficacy and safety of the new stereotactic radiation techniques in patients with NFPA, GH-, ACTH-or PRL-secreting pituitary adenomas. Methods. A systematic review was performed using PubMed and articles/abstracts and reviews detailing RT in pituitary adenomas from 2000 to 2017 were included. Results. Stereotactic radiosurgery (SRS) and fractionated stereotactic RT (FSRT) provide high rates of tumour control i.e. stable or decrease in tumour size, in all types of pituitary adenomas (median 92-98%) at 5 years. Endocrinological remission is however significantly lower: 44-52% in acromegaly, 54-64% in Cushing's disease and around 30% in prolactinomas at 5 years. The rate of new hypopituitarism varies from 10% to 50% at 5 years in all tumour types and as expected increases with the duration of follow-up (FU). The risk for other radiation-induced complications is usually low (0-5% for new visual deficits, cranial nerves damage or brain radionecrosis and extremely low for secondary brain tumours), however longer FU is needed to determine rates of secondary tumours. Notably, in acromegaly, there may be a higher risk for stroke with FSRT. Conclusion. Stereotactic radiotherapy can be an effective treatment option for patients with persistent or recurrent pituitary adenomas after unsuccessful surgery (especially if residual tumour is enlarging) and/or resistance or unavailability of medical therapy. Comparison with conventional radiation therapy (CRT) is rather difficult, due to the substantial heterogeneity of the studies. In order to evaluate the potential brain-sparing effect of the new stereotactic techniques, suggested by the current data, longterm studies evaluating secondary morbidity and mortality are needed.

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Predictors of Quality of Life in 165 Patients With Acromegaly: Results from a Single-Center Study

Cited by 26 publications

References 30 publications

Patient Characteristics, Diagnostic Delays, Treatment Patterns, Treatment Outcomes, Comorbidities, and Treatment Costs of Acromegaly in China: A Nationwide Study

Patient Characteristics, Diagnostic Delays, Treatment Patterns, Treatment Outcomes, Comorbidities, and Treatment Costs of Acromegaly in China: A Nationwide Study

A Pituitary Society update to acromegaly management guidelines

Stereotactic Radiation Therapy in Pituitary Adenomas, is it Better than Conventional Radiation Therapy

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