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Current management practices for acromegaly: an international survey

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Abstract

To determine whether peer-reviewed consensus statements have changed clinical practice, we surveyed acromegaly care in specialist centers across the globe, and determined the degree of adherence to published consensus guidelines on acromegaly management. Sixty-five acromegaly experts who participated in the 7th Acromegaly Consensus Workshop in March 2009 responded. Results indicated that the most common referring sources for acromegaly patients were other endocrinologists (in 26% of centers), neurosurgeons (25%) and primary care physicians (21%). In sixty-nine percent of patients, biochemical diagnoses were made by evaluating results of a combination of growth hormone (GH) nadir/basal GH and elevated insulin like growth factor-I (IGF-I) levels. In both Europe and the USA, neurosurgery was the treatment of choice for GH-secreting microadenomas and for macroadenomas with compromised visual function. The most widely used criteria for neurosurgical outcome assessment were combined measurements of IGF-I and GH levels after oral glucose tolerance test (OGTT) 3 months after surgery. Ninety-eight percent of respondents stated that primary treatment with somatostatin receptor ligands (SRLs) was indicated at least sometime during the management of acromegaly patients. In nearly all centers (96%), the use of pegvisomant monotherapy was restricted to patients who had failed to achieve biochemical control with SRL therapy. The observation that most centers followed consensus statement recommendations encourages the future utility of these workshops aimed to create uniform management standards for acromegaly.

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Acknowledgments

The authors thank the following participants in the Seventh Acromegaly Consensus Group meeting for their kind participation in this survey in advance of the meeting: John Ayuk, Birmingham, UK; Ariel Barkan, Ann Arbor, USA; Albert Beckers, Liege, Belgium; Paolo Beck-Peccoz, Milan, Italy; Bengt-Åke Bengtsson, Gothenburg, Sweden; Anat Ben-Shlomo, Los Angeles, USA; Jérôme Bertherat, Paris, France; John Bevan, Aberdeen, UK; Beverly Biller, Boston, USA; Jens Bollerslev, Oslo, Norway; Vivien Bonert, Los Angeles, USA; Marcello Bronstein, Sao Paulo, Brazil; Thierry Brue, Marseille, France; Michael Buchfelder, Erlangen, Germany; Philippe Caron, Toulouse, France; Davide Carvalho, Porto, Portugal; Felipe Casanueva, Santiago de Compostela, Spain; Franco Cavagnini, Milan, Italy; Philippe Chanson, Le Kremlin Bicetre, France; David Clemmons, Chapel Hill, USA; Annamaria Colao, Naples, Italy; Renato Cozzi, Milan, Italy; Ettore Degli Uberti, Ferrara, Italy; Laura De Marinis, Rome, Italy; Ernesto De Menis, Italy; Eva Marie Erfurth, Lund, Sweden; Rudolph Fahlbusch, Hannover, Germany; Diego Ferone, Genoa, Italy; Pamela Freda, New York, USA; Lawrence Frohman, Chicago, USA; Monica Gadelha, Rio de Janeiro, Brazil; Rolf Gaillard, Switzerland; Ezio Ghigo, Turin, Italy; Yona Greenman, Tel Aviv, Israel; Ashley Grossmann, London, UK; Feng Gu, Beijing, China; Amir Hamrahian, Cleveland, USA; Ian Holdaway, New Zealand; Ken Ho, Sydney, Australia; Jens Otto Jorgensen, Aarhus, Denmark; David Kleinberg, New York, USA; Anne Klibanski, Boston, USA; Steven Lamberts, Rotterdam, Netherlands; Edward Laws, Boston, USA; Gaetano Lombardi, Naples, Italy; Marco Losa, Milan, Italy; Pietro Maffei, Padua, Italy; Josef Marek, Prague, Czech Republic; Gherardo Mazziotti, Mantua, Italy; Moises Mercado, Mexico City, Mexico; Francesco Minuto, Genoa, Italy; Mark Molitch, Chicago, USA; Pietro Mortini, Brescia, Italy; Robert Murray, Leeds, UK; Stephan Petersenn, Essen, Germany; Ferdinand Roelfsema, Netherlands; Richard Ross, Sheffield, UK; Roberto Salvatori, Baltimore, USA; Janet Schlechte, Iowa City, USA; Jochen Schopohl, Munich, Germany; Omar Serri, Montreal, Canada; Guenter Stalla, Munich, Germany; Brooke Swearingen, USA; Mary Lee Vance, Charlottesville, USA; Aart Jan Van Der Lely, Rotterdam, Netherlands, Massimo Terzolo, Italy; George Tolis, Greece; John Wass, Oxford, UK; Susan Webb, Barcelona, Spain; Margaret Wierman, Denver, USA; Sema Yarman, Istanbul, Turkey. Editorial assistance was provided by John Clarke and Martin Gilmour (ESP Bioscience) supported by Ipsen.

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Authors and Affiliations

  1. Department of Medical and Surgical Sciences, University of Brescia, Endocrine Service, Montichiari Hospital, Via Ciotti 154, 25018, Montichiari, Italy

    A. Giustina

  2. Neuroendocrine Unit, Division of Endocrinology and Metabolism, University of Sao Paulo Medical School, Ribeirao Preto, Brazil

    M. D. Bronstein

  3. Division of Endocrinology CHUS, Department of Medicine, Santiago de Compostela University, Santiago de Compostela, Spain

    F. F. Casanueva

  4. Department of Endocrinology and Reproductive Diseases, Assistance Publique-Hôpitaux de Paris et Université Paris-Sud 11, Le Kremlin-Bicêtre, France

    P. Chanson

  5. Division of Endocrinology, University of Turin, Turin, Italy

    E. Ghigo

  6. Pituitary Research Unit, Garvan Institute of Medical Research, Sydney, Australia

    K. K. Y. Ho

  7. Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA

    A. Klibanski

  8. Department of Internal Medicine, Division of Endocrinology, Erasmus Medical Centre, Rotterdam, The Netherlands

    S. Lamberts

  9. Department of Endocrinology, Christie Hospital, Wilmslow Road, Manchester, UK

    P. Trainer

  10. Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA

    S. Melmed

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  1. A. Giustina
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  2. M. D. Bronstein
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  3. F. F. Casanueva
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  4. P. Chanson
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  5. E. Ghigo
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  6. K. K. Y. Ho
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  7. A. Klibanski
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  8. S. Lamberts
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  9. P. Trainer
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  10. S. Melmed
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Correspondence to A. Giustina.

Appendix: Survey of acromegaly global patterns of care

Appendix: Survey of acromegaly global patterns of care

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Giustina, A., Bronstein, M.D., Casanueva, F.F. et al. Current management practices for acromegaly: an international survey. Pituitary 14, 125–133 (2011). https://doi.org/10.1007/s11102-010-0269-9

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