The management of the patient with acromegaly and headache: A still open clinical challenge

Giustina, Andrea; Gola, M; Colao, Annamaria; Marinis, Laura De; Losa, Marco; Sicolo, Nicola; Ghigo, Ezio

doi:10.1007/bf03346442

Cited by 15 publications

(7 citation statements)

References 41 publications

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“…[11][12][13][14][15] A possible explanation for the differing responsiveness of symptoms to pegvisomant therapy may at first lie in the nature of the symptoms. In particular, pain syndromes, joint complaints and persistent headache seem to persist regardless of the therapy modality and/or biochemical control.…”

Section: Discussionmentioning

confidence: 99%

“…In particular, pain syndromes, joint complaints and persistent headache seem to persist regardless of the therapy modality and/or biochemical control. [11][12][13][14][15] A possible explanation for the differing responsiveness of symptoms to pegvisomant therapy may at first lie in the nature of the symptoms. Skin manifestations such as perspiration, soft tissue swelling or numbness caused by an increase in extracellular volume, oedema, dermal glycosaminoglycan accumulation or increased vasoconstriction are usually alleviated rapidly when GH/ IGF-1 over-secretion is controlled.…”

Section: Discussionmentioning

confidence: 99%

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Change of symptoms and perceived health in acromegalic patients on pegvisomant therapy: a retrospective cohort study within the German Pegvisomant Observational Study (GPOS)

Sievers

Brübach

Saller

et al. 2010

Clinical Endocrinology

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Change of symptoms and perceived health in acromegalic patients on pegvisomant therapy: a retrospective cohort study within the German Pegvisomant Observational Study (GPOS)

Sievers

Brübach

Saller

et al. 2010

Clinical Endocrinology

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“…Although the first recommendation was proposed to reduce embryo exposure to drug in relation to the residual exposure with the long-acting analog, it requires more meticulous conception planning that is often difficult to implement in clinical practice. On the other hand, the following recommendation to reintroduce the medication for headache control, as stated, might lead to more and unnecessary fetal exposure to octreotide as headache after withdrawal of short-acting octreotide is more frequent and more severe than that after withdrawal of long-acting octreotide (70), which is usually responsive to safer analgesics (5).…”

Section: Treatment Of Acromegaly During Pregnancymentioning

confidence: 99%

MANAGEMENT OF ENDOCRINE DISEASE: Acromegaly and pregnancy: a contemporary review

Abucham

Bronstein

Rodrigues

2017

European Journal of Endocrinology

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Although fertility is frequently impaired in women with acromegaly, pregnancy is apparently becoming more common due to improvement in acromegaly treatment as well as in fertility therapy. As a result, several studies on pregnancy in patients with acromegaly have been published in recent years adding new and relevant information to the preexisting literature. Also, new GH assays with selective specificities and the knowledge of the expression of the various GH genes have allowed a better understanding of somatotrophic axis function during pregnancy. In this review, we show that pregnancy in women with acromegaly is generally safe, usually with tumoral and hormonal stability. Although the paucity of data limits evidence-based recommendations for preconception counseling and pregnancy surveillance, controlling tumor size and hormonal activity before pregnancy is highly recommended to ensure better outcomes, and surgical control should be attempted when feasible. Treatment interruption at pregnancy confirmation has also proven to be safe, as drugs are not formally allowed to be used during pregnancy. Drug exposure (somatostatin analogs) during early or whole pregnancy might increase the chance of a lower birth weight. Aggressive disease is uncommon and may urge individual decisions such as surgery or drug treatment during pregnancy or lactation.Correspondence should be addressed to J Abucham

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“…However, if symptoms persist after biochemical control, patients may require surgical release [ 29 ]. Lastly, the prevalence of headache in acromegaly is reported in 37 to 87 % of patients, and can be a significant contributor to reduced quality of life [ 87 ]. The pathophysiology of pituitary tumor-associated headaches is not fully understood, and the resolution of headache after surgery or GH control is not always achieved [ 88 ].…”

Section: Introductionmentioning

confidence: 99%

Challenges in the diagnosis and management of acromegaly: a focus on comorbidities

et al. 2016

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IntroductionAcromegaly is a rare, insidious disease resulting from the overproduction of growth hormone (GH) and insulin-like growth factor 1 (IGF-1), and is associated with a range of comorbidities. The extent of associated complications and mortality risk is related to length of exposure to the excess GH and IGF-1, thus early diagnosis and treatment is imperative. Unfortunately, acromegaly is often diagnosed late, when patients already have a wide range of comorbidities. The presence of comorbid conditions contributes significantly to patient morbidity/mortality and impaired quality of life.MethodsWe conducted a retrospective literature review for information relating to the diagnosis of acromegaly, and its associated comorbidities using PubMed. The main aim of this review is to highlight the issues of comorbidities in acromegaly, and to reinforce the importance of early diagnosis and treatment.Findings and conclusionsSuccessful management of acromegaly goes beyond treating the disease itself, since many patients are diagnosed late in disease evolution, they present with a range of comorbid conditions, such as cardiovascular disease, diabetes, hypertension, and sleep apnea. It is important that patients are screened carefully at diagnosis (and thereafter), for common associated complications, and that biochemical control does not become the only treatment goal. Mortality and morbidities in acromegaly can be reduced successfully if patients are treated using a multimodal approach with comprehensive comorbidity management.

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The management of the patient with acromegaly and headache: A still open clinical challenge

Cited by 15 publications

References 41 publications

Change of symptoms and perceived health in acromegalic patients on pegvisomant therapy: a retrospective cohort study within the German Pegvisomant Observational Study (GPOS)

Change of symptoms and perceived health in acromegalic patients on pegvisomant therapy: a retrospective cohort study within the German Pegvisomant Observational Study (GPOS)

MANAGEMENT OF ENDOCRINE DISEASE: Acromegaly and pregnancy: a contemporary review

Challenges in the diagnosis and management of acromegaly: a focus on comorbidities

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