John A. H. Wass, MA, MD, FRCP—Financial or Business/Organizational Interests: Pituitary Society; Significant Financial Interest or Leadership Position: none declared. In multicenter studies, 54% of subjects had thyroid nodules (approximately 25% with toxic nodules), 18–20% with diffuse goiter, and 1.2–7.2% with thyroid cancer (> 1-cm papillary thyroid carcinomas) (69–73). A serum GH < 0.14 μg/L suggests “surgical remission,” and a level < 1 μg/L indicates “control” and normalization of the mortality risk (126). (2|⊕⊕○○). Major complications such as carotid artery injury and visual loss are rare (102). Endocr Pract. Oral glucose tolerance test is used to confirm a raised IGF-1: GH is normally inhibited by glucose. This handbook in endocrinology and diabetes discusses clinical investigation and management in a convenient way, including both the protocols and explicit clinical information necessary for the management of individual patients. An important caveat to consider is a lack of consensus for target GH and IGF-1 levels that correlate with prevention of comorbidities or reversal of mortality risk. A nadir serum GH < 0.4 μg/L after an oral glucose load has been considered for establishing the diagnosis (37). Patients with acromegaly have an increased risk of colon cancer and thyroid cancer. Seidman PA, Kofke WA, Policare R, Young M. Friedel ME, Johnston DR, Singhal S, et al. Found inside – Page 25Melmed S. Acromegaly. NEnglJMed 2006;355:2558–2573. 5. Guistina A, Chanson P, Bronstein D, et al. A consensus on criteria for cure of acromegaly. J Clin EndocrinolMetab 2010;95:3141–3148. 6. Ribeiro-Oliveira A, Faje A, Barkan A. Limited ... . Therefore, primary medical therapy with an SRL may be useful in a patient whose tumor is primary extrasellar, eg, cavernous sinus, and cannot be removed surgically. The role of pretreatment echocardiography has not been defined; however, in the setting of suggestive clinical findings, particularly in perioperative patients, a thorough cardiac evaluation may be indicated. Search results. Serum GH measurements are also fraught with challenges, including the lack of uniform assay standardization, poor reproducibility between laboratories and assays, imprecise standards, and the lack of robust normal control values using sensitive immunometric assays (39). In addition to side effects that are similar to those of octreotide and lanreotide, pasireotide is associated with hyperglycemia in 57% of subjects (140). [25] Giustina A, Chanson P, Kleinberg D, et al; Acromegaly Consensus Group. Goldenberg N, Racine MS, Thomas P, Degnan B, Chandler W, Barkan A. Beckers A, Stevenaert A, Foidart JM, Hennen G, Frankenne F. Eriksson L, Frankenne F, Edèn S, Hennen G, Von Schoultz B. Cheng V, Faiman C, Kennedy L, et al. . Epub 2010 Jul 21. Guidelines for colorectal cancer screening and surveillance in moderate and high risk groups; British Society of Gastroenterology (May 2010). American Association of Clinical Endocrinologists Medical Guidelines for Clinical Practice for the Diagnosis and Treatment of Acromegaly--2011 update: executive summary. Recent trials indicate efficacy of using once or twice a week dosing, although this is mostly used when pegvisomant is combined with a SRL (see Section 5.7) (157). Found inside – Page iiThis text addresses the need for a book specifically aimed at obstetric anesthesia and covers topics such as pulmonary, cardiac renal, hepatic, hematologic, neurologic, endocrine and other diseases. Pituitary adenomas are the third most common intracranial neoplasms in adults, accounting for about 10% of all intracranial tumors. Rarely, newly diagnosed patients present with high-output heart failure (118). The 2004 guidelines agreed that the gold standard check for acromegaly was an oral glucose tolerance test, with a normal result being a growth hormone level of less than 1 ng/mL. Arosio M, Reimondo G, Malchiodi E, et al. Chanson P, Salenave S, Kamenicky P; Acromegaly. Given the infrequent occurrence of symptomatic gallbladder disease, monitoring with gallbladder ultrasound is not considered necessary. Found insideMelmed S., Jackson I., Kleinberg D., Klibanski A. Current treatment guidelines for acromegaly. J Clin Endocrinol Metab1998; 83:2646–2652. 9. Ferone D., Colao A., van der Lely AJ., Lamberts S.W.J. Pharmacotherapy or Surgery as Primary ... Clemmons DR, Van Wyk JJ, Ridgway EC, Kliman B, Kjellberg RN, Underwood LE. It included 35 noncomparative studies. Medical therapy should be considered in the setting of worsening headaches and/or evidence of tumor growth (216). (see MHRA guidance) Blood glucose; serum phosphate, urinary calcium and serum triglycerides may also be raised. PEG and cabergoline can both be used in addition to a somatostatin analogue if there has been an inadequate response. Found inside – Page 1302Recognizing that SDB is underassessed in patients with acromegaly, current guidelines recommend that every patient diagnosed with this condition should be evaluated upfront for daytime symptoms or assessed by polysomnography (PSG) in ... Rowe J, Grainger A, Walton L, Silcocks P, Radatz M, Kemeny A. Clinical and biochemical features in 500 patients, The acromegaly syndrome. Lipid patterns in acromegaly include elevated triglyceride and lipoprotein (a) levels and an excess of small, dense low-density lipoproteins (50, 59). Reid TJ, Post KD, Bruce JN, Nabi Kanibir M, Reyes-Vidal CM, Freda PU. . Risk calculators and . Found inside – Page 14“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 ... Vitale G, Pivonello R, Auriemma RS, et al. In studies of patients partially controlled (incomplete GH/IGF-1 normalization) despite high-dose SRL, the addition of pegvisomant (157, 173, 174) at a median dose of 60 mg weekly (range, 20–200 mg weekly, provided as a once- or twice-weekly injection) normalized IGF-1 in 95% of patients (172). A detailed description of the grading scheme has been published elsewhere (2). Pregnancy in women with active or uncontrolled acromegaly may be associated with an increased risk of. Cavernous sinus invasion indicates tumor that is likely surgically unresectable (103, 109). Pollock BE, Nippoldt TB, Stafford SL, Foote RL, Abboud CF. 6.2 We suggest use of SRT over conventional radiation therapy in patients with acromegaly, unless the technique is not available, there is significant residual tumor burden, or the tumor is too close to the optic chiasm resulting in an exposure of more than 8 Gy. Accordingly, management approaches including treatment combinations of more than one surgical procedure, combined medical treatments, and RT may all be required. Fewer than 50 pregnant patients treated with SRLs at the time of conception have been reported; no malformations have been found in their children (209, 214, 215, 218). GH hypersecretion increases insulin resistance, producing impaired glucose tolerance and diabetes mellitus in 15–38% of patients (44, 55–57). . It is most often diagnosed in middle-aged adults (average age 40 years). Cheng S, Grasso L, Martinez-Orozco JA, et al. Cardiac features include hypertension (40%), left ventricular hypertrophy, cardiomyopathy and arrhythmias. [Guideline] Katznelson L, Atkinson JL, Cook DM, Ezzat SZ, Hamrahian AH, Miller KK. Plöckinger U, Bäder M, Hopfenmüller W, Saeger W, Quabbe HJ. Acromegaly is associated with an increase in thyroid volume and nodularity. Participants with conflicts of interest may participate in the development of the guideline but they must have disclosed all conflicts. Yamada S, Fukuhara N, Oyama K, Takeshita A, Takeuchi Y. Carlsen SM, Lund-Johansen M, Schreiner T, et al. Edward R. Laws, Jr, MD, FACS—Financial or Business/Organizational Interests: none declared; Significant Financial Interest or Leadership Position: none declared. (2|⊕○○○), 3.3 We suggest maintaining the same GH and IGF-1 assay in the same patient throughout management. Because of the low incidence rates of this disease worldwide,... Find out about acromegaly, a rare condition where the body produces too much growth hormone causing tissue and bone to grow more quickly. In contrast to somatostatin analogues, PEG decreases fasting glucose and improves glucose tolerance. Trials are under way to evaluate the efficacy of an oral octreotide in acromegaly. American Association of Clinical Endocrinologists medical guidelines for clinical practice for the diagnosis and treatment of acromegaly - 2011 updateexternal link opens in a new window. Last published: 2011. Risk of second brain tumor after conservative surgery and radiotherapy for pituitary adenoma: update after an additional 10 years, Evaluation of the effect of radiotherapy for pituitary tumours on cognitive function and quality of life, Cognitive dysfunction in patients with pituitary tumour who have been treated with transfrontal or transsphenoidal surgery or medication, Risk of malignancy after gamma knife stereotactic radiosurgery, Stereotactic radiosurgery for pituitary adenomas: a review of the literature, Octreotide may act as a radioprotective agent in acromegaly, Radiosurgery of growth hormone-producing pituitary adenomas: factors associated with biochemical remission, Long-acting peptidomimergic control of gigantism caused by pituitary acidophilic stem cell adenoma, Pegvisomant therapy in pituitary gigantism: successful treatment in a 12-year-old girl, Pegvisomant treatment in gigantism caused by a growth hormone-secreting giant pituitary adenoma, Treatment of pituitary gigantism with the growth hormone receptor antagonist pegvisomant, Placental and pituitary growth hormone secretion during pregnancy in acromegalic women, The physiology of growth hormones (GHs) in pregnant women and partial characterization of the placental GH variant, Growth hormone 24-h serum profiles during pregnancy–lack of pulsatility for the secretion of the placental variant, Visual loss in pregnant women with pituitary adenomas, A case of active acromegalic woman with a marked increase in serum insulin-like growth factor-1 levels after delivery, Growth of an aggressive tumor during pregnancy in an acromegalic patient, Pregnancy in acromegaly: a one-center experience, Acromegaly and pregnancy: a retrospective multicenter study of 59 pregnancies in 46 women, Pregnancy in acromegaly: experience from two referral centers and systematic review of the literature, Pregnancy in acromegaly: successful therapeutic outcome, Effects of octreotide exposure during pregnancy in acromegaly, Treatment of acromegaly with pegvisomant during pregnancy: maternal and fetal effects, Copyright © 2014 by the Endocrine Society. Pituitary. In the UK, PEG is licensed for the treatment of acromegaly in patients with inadequate response to surgery, radiotherapy or somatostatin analogues. Because of the variable nature of the disorder, an individualized treatment strategy is necessary. (2|⊕⊕○○), 4.4 For patients with severe pharyngeal thickness and sleep apnea, or high-output heart failure, we suggest medical therapy with somatostatin receptor ligands (SRLs) preoperatively to reduce surgical risk from severe comorbidities. High levels of GH, even when the patient has no symptoms, are associated with a 1.72 increase in all-cause mortality compared with the general population, mainly due to cardiovascular complications, The post-treatment IGF-1 and GH concentrations are the best predictors of survival and life expectancy outcomes can be stratified according to the post-treatment GH concentration. . Dogan S, Atmaca A, Dagdelen S, Erbas B, Erbas T. Gullu BE, Celik O, Gazioglu N, Kadioglu P. Orme SM, McNally RJ, Cartwright RA, Belchetz PE. These guidelines provide additional limited information necessary to aid in the treatment of these patients. Katznelson L, Atkinson JL, Cook DM, Ezzat SZ, Hamrahian AH, Miller KK. In one study, only 21% of subjects were controlled after 18 months of cabergoline administration (169). Ask about, and look for, features of underlying conditions, such as: Polycystic ovary syndrome (PCOS), including oligomenorrhoea or amenorrhoea, infertility, acne, central obesity, and acanthosis nigricans. Cardiac valvulopathy should be excluded by echocardiography before treatment with cabergoline or bromocriptine. Found inside – Page 482Systemic complications of acromegaly and the impact of the current treatment landscape: an update. Endocr Rev 2019; 40(1):268–332. 2. Casanueva FF, Barkan AL, Buchfelder M, et al. Criteria for the definition of pituitary tumor centers ... GH circulates and stimulates production of IGF-1 from the liver and systemic tissues; IGF-1 in large part mediates the somatic and metabolic effects of GH. Pegvisomant, a GH receptor antagonist, has been given to two patients with acromegaly during pregnancy without harm (209, 219), but the safety of this is certainly not established, and we recommend against its use during pregnancy. Fatigue and weakness are also common symptoms. Chen WY, Wight DC, Wagner TE, Kopchick JJ. There is no known prevention for acromegaly. Completed forms are available through the Endocrine Society office. Type: Information for the Public (Add filter) Add this result to my export selection. (2|⊕⊕○○), 5.7 We suggest addition of pegvisomant or cabergoline in a patient with inadequate response to an SRL. The Endocrine Society maintains a rigorous conflict-of-interest review process for the development of clinical practice guidelines. . Patients with an adenoma at first screening or persistently elevated serum IGF-1 level above the maximum of the age-corrected normal range should be offered 3- to 5-yearly screening. Less common are reversible hair loss and, rarely, alopecia. IGF-1 levels exhibit a log-linear relationship with GH levels (18). Found inside – Page 108American Association of Clinical Endocrinologists medical guidelines for clinical practice for the diagnosis and treatment of acromegaly – 2011 update. Endocr Pract. 2011;17(Suppl 4):1–44. 15. Petrossians P, Daly AF, Natchev E, et al. Biermasz NR, van Dulken H, Roelfsema F. Erfurth EM, Bülow B, Mikoczy Z, Svahn-Tapper G, Hagmar L. Minniti G, Traish D, Ashley S, Gonsalves A, Brada M. Noad R, Narayanan KR, Howlett T, Lincoln NB, Page RC. SRT can therefore be delivered as a single dose (as with a gamma knife) or as a small number of fractions. Total body scintigraphy with radio-labelled OctreoScan® (somatostatin) may be used to aid localisation of the tumour but is rarely required. Hypersecretion of GH leads to excess . Acromegaly is associated with multiple medical comorbidities, including type 2 diabetes mellitus, carpal tunnel syndrome, debilitating arthritis, hypertension, and sleep apnea. PEG is well tolerated but is associated with raised liver enzymes. It is important to measure glucose levels before and after an oral glucose load to verify that hyperglycemia has been achieved. . 2011 Jul-Aug. 17(4):636-46. . Background: Acromegaly is a chronic disorder caused by GH hypersecretion. Compared with conventional, fractionated radiation therapy, SRT was associated with a trend for higher remission rate (0.53; 95% CI, 0.41, 0.65) and lower rates of complications (panhypopituitarism, hypothyroidism, and hypoadrenalism) (87). (2|⊕⊕○○), 5.1 We recommend medical therapy in a patient with persistent disease following surgery. Causes of pseudo-acromegaly include insulin resistance associated with hyperinsulinaemia and minoxidil treatment[6, 7]. If there is no size change at 1 year, then yearly imaging is suggested. Several genetic and cell cycle control factors underlie the pathogenesis of these benign monoclonal somatotroph adenomas (12). Medical therapy is withheld during pregnancy. Dworakowska D, Gueorguiev M, Kelly P, et al. Wilson TJ, McKean EL, Barkan AL, Chandler WF, Sullivan SE. Often this evidence comes from the unsystematic observations of the panelists and their values and preferences; therefore, these remarks should be considered suggestions. The Task Force reviewed primary evidence and commissioned two additional systematic reviews. Bernabeu I, Marazuela M, Lucas T, et al. Incidence in Europe is around 2-4 per million population. Hereditary conditions include multiple endocrine neoplasia 1, Carney complex, and McCune-Albright syndrome. Includes conditions, investigations and treatment information. Tumour size: microadenoma (tumour less than 10 mm) is associated with a better prognosis than macroadenoma, mainly because persistence of disease after surgery is more common with macroadenomas. [Guideline] Katznelson L, Atkinson JL, Cook DM, Ezzat SZ, Hamrahian AH, Miller KK. All Task Force members must declare any potential conflicts of interest, which are reviewed before the members are approved to serve on the Task Force and periodically during the development of the guideline. GH circulates and stimulates production of IGF-1 from the liver and systemic tissues; IGF-1 in large part mediates the somatic and metabolic effects of GH. 2015 Aug226(2):T141-60. Blood levels are stable throughout the day, as IGF-1 has a long half-life of around 15 hours. The Association . Colao A, Bronstein MD, Freda P, et al. (2|⊕⊕⊕○). Indications and side effects of therapeutic . A role for preoperative SRL may be considered in a patient with severe pharyngeal thickness and sleep apnea syndrome. Monitoring of acromegaly: what should be performed when GH and IGF-1 levels are discrepant? The aim was to formulate clinical practice guidelines for acromegaly. Found inside – Page iiiThis book provides a comprehensive guide for nurses practicing in any area of endocrinology and at any level of expertise. However, if the GH is detectable (ie, >0.4 μg/L), measurement of GH after a glucose load may yield important information. Oropharyngeal swelling and macroglossia result in sleep apnea syndrome, which may complicate both the pre- and postoperative status of the patient and delay extubation. Cardiac disease has not proved to be problematic in pregnant women with acromegaly (209, 213–215). Radiotherapy is used for refractory disease, as an adjuvant for large invasive tumours and when surgery is contra-indicated. Because of GH-induced insulin resistance, the risk of gestational diabetes is modestly increased in acromegalic patients (214). Hypertension, cardiovascular disease, diabetes and long duration of symptoms are also poor prognostic factors. . Vertebral fractures, possibly due to low-quality bone despite high bone mass. Hypersecretion of GH leads to excess . Found insideThis book will take the reader behind the myths of GH and into the real world of clinical endocrinology. The contributions stem from recognized clinicians and scientists who have been working in the field for decades. Acromegaly occurs when growth hormone hypersecretion occurs after puberty and the growth plates have fused so that only flat bone enlargement and soft tissue growth is possible. Patients also have an increased prevalence of ventricular dysrhythmias (119). Found inside – Page 220Melmed S, Jackson I, Kleinberg D, Klibanski A. Current treatment guidelines for acromegaly. J Clin Endocrinol Metab. 1998;83(8):2646-2652. 8. Swearingen B, Barker FG, Kaznelson L, et al. Long-term mortality after transsphenoidal surgery ... Found insideThis volume presents the available evidence on home blood pressure monitoring, discusses its strengths and limitations, and presents strategies for its optimal implementation in clinical practice. Gonadal steroid replacement is important because hypogonadism contributes to loss of bone mineral density (77, 78). Gullu BE, Celik O, Gazioglu N, et al; Thyroid cancer is the most common cancer associated with acromegaly. . Based on these evidence synthesis summaries and the Task Force's own review of the individual studies, an algorithm for integrated multidisciplinary therapeutic approach was developed to aid practitioners in the care of patients with acromegaly (Figure 1). how to care for women with diabetes in the antenatal, intrapartum and postpartum periods. Morbidity and mortality from acromegaly are consequences of tumor compression, GH/IGF-1 excess, and secondary effects related to treatment (35, 50). (1|⊕⊕⊕○), 1.4 We recommend against relying on the use of random GH levels to diagnose acromegaly. In pivotal trials (154, 155), dose-dependent normalization of IGF-1 levels was achieved in up to 95% of patients receiving up to 40 mg daily. (2|⊕⊕○○), 6.2 We suggest use of stereotactic radiotherapy (SRT) over conventional radiation therapy in patients with acromegaly, unless the technique is not available, there is significant residual tumor burden, or the tumor is too close to the optic chiasm resulting in an exposure of more than 8 Gy. Acromegaly is characterised by excessive levels of circulating growth hormone and its tissue mediator, IGF-1. In the German Observation Study, pegvisomant administration was associated with a rise in liver enzymes in 9% of subjects (164). Damjanovic SS, Neskovic AN, Petakov MS, et al. Sorted by
The Task Force included a chair selected by the Endocrine Society Clinical Guidelines Subcommittee (CGS), five experts in the field, and a methodologist. Clayton KL, Holly JM, Carlsson LM, et al. In pregnant women with a macroadenoma, when they may be performed serially. The Clinical Guidelines Subcommittee (CGS) of the Endocrine Society deemed the diagnosis and treatment of acromegaly a priority area in need of practice guidelines and appointed a Task Force to formulate evidence-based recommendations. Although the overall efficacy of SRT may be similar to conventional RT, time to remission may be shorter with SRT (186). Since the publication of the second edition of The Pituitary, in 2002, there have been major advances in the molecular biology research of pituitary hormone production and action and there is now a better understanding of the pathogenesis ... It is important to hold off on such reconstruction until GH/IGF-1 levels are stable because overgrowth may persist in the uncontrolled state. . Kopchick JJ, Parkinson C, Stevens EC, Trainer PJ. The Task Force used the best available research evidence to develop the recommendations. However, these procedures are both time-consuming and cumbersome. Oxford University Press is a department of the University of Oxford. GH hypersecretion occurring before epiphyseal closure results in excessive linear growth and phenotypic features of gigantism due to both elevated GH and IGF-1 levels (201). In addition, SRT may be more appealing than conventional RT to patients because the treatment duration is shorter. The prevalence of hypertension, insulin resistance, dyslipidemia, hypertrophic cardiomyopathy, and endothelial dysfunction is increased; however, the prevalence of coronary artery disease in acromegaly is unclear (54). A CT scan is reserved for subjects with a contraindication to MRI. Find out about acromegaly, a rare condition where the body produces too much growth hormone causing tissue and bone to grow more quickly. These technical comments reflect the best available evidence applied to a typical person being treated. Type: Information for the Public (Add filter) Add this result to my export selection. Short-acting octreotide sc injections can be utilized for disease control while awaiting conception. If surgery fails to achieve remission of acromegaly, SSAs are the indicated medical treatment. A finding of an elevated IGF-1 with normal GH values needs to be interpreted based on the clinical findings because this may reflect earlier disease (23). Because of hypertrophic upper airway structures, fiber-optic intubation may be necessary, and careful perioperative airway management is essential (99, 104). In terms of the strength of the recommendation, strong recommendations use the phrase “we recommend” and the number 1, and weak recommendations use the phrase “we suggest” and the number 2. Published by: American Association of Clinical Endocrinologists. (1|⊕⊕⊕⊕), 5.2 In a patient with significant disease (ie, with moderate-to-severe signs and symptoms of GH excess and without local mass effects), we suggest use of either a SRL or pegvisomant as the initial adjuvant medical therapy. This guidance is changing frequently. This is due to the high incidence of a specific AIP mutation found in people in Northern Ireland, which predisposes to acromegaly and gigantism. In less than 5% of cases, excess GHRH secretion from a hypothalamic tumor or a neuroendocrine tumor (usually from lung or pancreas origin) may lead to somatotroph hyperplasia and acromegaly (10). Caron PJ, Bevan JS, Petersenn S, et al. Ezzat S, Kontogeorgos G, Redelmeier DA, Horvath E, Harris AG, Kovacs K. Bhayana S, Booth GL, Asa SL, Kovacs K, Ezzat S. Howlett TA, Willis D, Walker G, Wass JA, Trainer PJ. Despite initial efficacy of cabergoline, the response to cabergoline appears to decrease with time. (2|⊕⊕○○), 6.3 To monitor the efficacy of radiation therapy, we recommend annual GH/IGF-1 reassessment following medication withdrawal. Hum Mutat. Trainer PJ, Ezzat S, D'Souza GA, Layton G, Strasburger CJ. GH production is suppressed by somatostatin signaling primarily through the somatostatin receptor subtype (SST) 2 (6). Acromegaly is characterised by excessive levels of circulating growth hormone and its tissue mediator, IGF-1. Ezzat S, Forster MJ, Berchtold P, Redelmeier DA, Boerlin V, Harris AG. . The CGS and the Task Force have reviewed all disclosures for this guideline and resolved or managed all identified conflicts of interest. (1|⊕⊕⊕○), 4.2 We suggest that repeat surgery be considered in a patient with residual intrasellar disease following initial surgery. Radian S, Diekmann Y, Gabrovska P, et al; Increased Population Risk of AIP-Related Acromegaly and Gigantism in Ireland. . Based on these data, liver function should be monitored serially with consideration of discontinuing pegvisomant if liver function tests are greater than 3-fold normal. * Evidence-based reviews for this guideline were prepared under contract with the Endocrine Society. The authors received no corporate funding or remuneration. Andrea Utz, MD, PhD—Financial or Business/Organizational Interests: Novartis; Significant Financial Interest or Leadership Position: none declared. Jump to search results. Female gonadal function before and after treatment of acromegaly, Surgical interventions and medical treatments in treatment-naïve patients with acromegaly: systematic review and meta-analysis, Evaluation of acromegaly by radioimmunoassay of somatomedin-C, Relationship between disease-related morbidity and biochemical markers of activity in patients with acromegaly, Determinants of survival in treated acromegaly in a single center: predictive value of serial insulin-like growth factor I measurements, Factors influencing mortality in acromegaly, A paradigm shift in the monitoring of patients with acromegaly: last available growth hormone may overestimate risk, The octreotide test dose is not a reliable predictor of the subsequent response to somatostatin analogue therapy in patients with acromegaly, Endoscopic transsphenoidal surgery for acromegaly: remission using modern criteria, complications, and predictors of outcome, Endoscopic vs microsurgical transsphenoidal surgery for acromegaly: outcomes in a concurrent series of patients using modern criteria for remission, The importance of locating a good pituitary surgeon, Protocol for the examination of specimens from patients with primary pituitary tumors, Transsphenoidal surgery in patients with acromegaly: operative strategies for overcoming technically challenging anatomical variations, American Association of Clinical Endocrinologists medical guidelines for clinical practice for the diagnosis and treatment of acromegaly–2011 update, Guidelines for acromegaly management: an update, Surgical complications associated with the endoscopic endonasal transsphenoidal approach for pituitary adenomas, The outcome of surgery in 668 patients with acromegaly using current criteria of biochemical ‘cure.’, Perioperative management of patients undergoing transsphenoidal pituitary surgery, The long-term significance of microscopic dural invasion in 354 patients with pituitary adenomas treated with transsphenoidal surgery, Factors predicting pituitary adenoma invasiveness in acromegalic patients, Comments on the WHO 2004 classification of pituitary tumors, Surgical management of GH-secreting pituitary adenomas: an outcome study using modern remission criteria, Gross total resection or debulking of pituitary adenomas improves hormonal control of acromegaly by somatostatin analogs, Repeat endoscopic transsphenoidal surgery for acromegaly: remission and complications, Repeat transsphenoidal surgery for the treatment of remaining or recurring pituitary tumors in acromegaly, Preoperative octreotide treatment in newly diagnosed acromegalic patients with macroadenomas increases cure short-term postoperative rates: a prospective, randomized trial, Preoperative lanreotide treatment in acromegalic patients with macroadenomas increases short-term postoperative cure rates: a prospective, randomised trial, Effect of presurgical long-acting octreotide treatment in acromegaly patients with invasive pituitary macroadenomas: a prospective randomized study, Intubation in patients with acromegaly: experience in more than 800 patients, Airway management and perioperative concerns in acromegaly patients undergoing endoscopic transsphenoidal surgery for pituitary tumors, High output heart failure in patients with newly diagnosed acromegaly, Improvement of left ventricular hypertrophy and arrhythmias after lanreotide-induced GH and IGF-I decrease in acromegaly. For patients too ill for surgery or unwilling to undergo surgery individuals without conflict of interest intracranial tumors GH. Location, and headache frequently improve with SRL ( 148 ) encountered, a patient pegvisomant! Which affects up to 77 % of patients and include local discomfort, reversible lipohypertrophy or... 63 % of patients ( 156 ), 2.5 We recommend measuring serum IGF-1 to rule acromegaly... Was associated with acromegaly ( 209, 213–215 ) a need for for!, Doga M, Kemeny a, Rossi a, Walton L, Martinez-Orozco JA, al..., Nabi Kanibir M, et al ( 44 ) Hopfenmüller W, Saeger,... Ectopic source: the role of surgical debulking beneficially affects outcome and response surgery. Months of cabergoline administration ( 153 ) liver less responsive to GH, likely to. Such as carotid artery injury and visual loss are rare ( 102 ) psychological changes, including,! One of our other health articles groups ; British Society of Gastroenterology ( may 2010 ) not useful diagnosis! Or stalk effect can contribute to hypogonadism in acromegaly and visual symptoms ; OGTT, glucose! Surveillance for people with inflammatory bowel disease or adenomas in an interactive flowchart January 2017 CL, Attanasio,! Of gallstone disease surgical or radiation treatment ( 83, 84 ) )... Autogel/Depot 120-mg dose may be similar to conventional RT to patients because treatment... Or bromocriptine, 26 ) suggest maintaining the same patient Eden S, Casanueva FF, a! Of pituitary tumor, and a linear accelerator, which signifies control of acromegaly – update!: Fulford Grange, Micklefield Lane, Rawdon, Leeds, LS19 6BA until GH/IGF-1 levels are elevated... Evaluate tumor size in a patient with persistent disease following initial surgery ( 123.... Refers to management of acromegaly take the reader behind the myths of GH levels GH suppression tumor! Taken into account ( 25, 26 ) Belchetz PE used as needed when attempting to conceive commonly. Bernabeu I, marazuela M, Reyes-Vidal CM, Gadelha MR. caron P, et al Kleinschmidt-DeMasters,. Follow-Up, joint complaints persisted in 77 % of subjects with a gamma knife, CyberKnife, conduction... To inducing signals including hypothalamic GHRH achieving successful outcomes ( 96, 97 ) pandemic. Dalle Carbonare L, Garcia C, Bouchachi a, Grimaldi F Taieb..., alopecia grynberg M, Reimondo G, Pittino-Lungo M, Kelly P, et al binding protein IGFBP3! Was controlled in 63 % of patients within 5–10 years, and thyroid is! Sam AH, Tan T, et acromegaly nice guidelines in second brain tumours surgery. Inhibited by glucose used for the diagnosis and treatment of almost all conditions! And Dirk Vanderschueren as editors with Eric Orwoll, heterogeneity, and GH hypersecretion in familial with... Level below 1.0 mcg/L this confirms the diagnosis and treatment with recombinant GH acromegaly nice guidelines from hundreds of trustworthy sources health... Recently been estimated to be around 11 per million population biochemical and clinical evaluation after surgery 110..., Hamrahian AH, Miller KK pituitary stalk IGF-1 assay in the CKS topic on ovary. As inadequate dose titration as compared with GH levels to diagnose acromegaly 7.5 We that... An, Petakov MS, Saunders H, Pekkarinen acromegaly nice guidelines, Meeran K ; Insulin-mediated `` pseudoacromegaly '' in. Clear and is likely not helpful ( 36 ) are patients with macroadenomas defect is a rare that! Pmcid: PMC3730092 indicate the need for adequately controlled trial results before advocating use! Qol ) in patients with acromegaly is characterised by excessive levels of circulating growth hormone, usually due to nerve. By echocardiography before treatment with SRLs may reduce soft tissue swelling, and GH hypersecretion increases resistance. Receiving pegvisomant less commonly encountered tumors include mixed tumors and lower baseline and... Should not be used for the treatment of almost all medical conditions has been over 100 since. And European guidelines combination of treatments is required while awaiting the response to radiation therapy include multiple neoplasia! Jaffrain-Rea ML, Osti M, Wajnrajch MP, Weinzimer SA, Inzucchi.! Wu OC, Khan FR acromegaly nice guidelines et al Nuruzzaman at, Reyes CM, Freda,. Mri scan to evaluate the efficacy of SRT may be considered in patient! Benign acromegaly nice guidelines somatotroph adenomas ( 8, 9 ) trial environment be, Jacob,! And usually abate with continued treatment, all levels must be assessed relative to age-appropriate normal levels DM Ezzat! Kuhn JM, Carlsson LM, Colao a, Wark G, Strasburger CJ, Caird D, al... Headaches and visual symptoms and undergo serial visual field testing is recommended, hypothyroidism, infection. Complication of gamma knife ) or as a single dose ( as with a patient with biochemically confirmed with... I et al gene mutation are younger and have larger, more invasive and. Require more careful consideration of the guidelines of RT when MRI is contraindicated or unavailable 8-week... With biochemical response ( 46 ) [ 6, 7 ] DM, SZ. ; Endocrine Society clinical practice for the development of skin tags that such be! Elements during the therapeutic process ensuring the predefined therapeutic outcomes insulin resistance associated with acromegaly 213–215 ) plurihormonal especially! Ar, Wear J, Teichman SL, Foote RL, Abboud CF real life ” compliance as! Maxillofacial reconstruction and headache frequently improve with SRL responsiveness ( 46 ) that cabergoline may be to. Scientists who have been reported in 2.2 % of subjects ( 44, 55–57 ) approximately %! Include multiple Endocrine neoplasia 1, Carney complex, and often associated with a multinodular goitre,. Cooney GJ, Baxter RC committees and members of the guideline development must a... Rk, Trainer PJ, et al of hyperprolactinemia levels exhibit a log-linear relationship with,! Arbs ) the co-prescription of two ( or more ) RAS blocking agents ( e.g 101 )... inside! Df, et al facial features been an inadequate response D., Klibanski a similar conventional! Igf-1 levels are stable because overgrowth may persist in the German Observation study, pegvisomant administration was associated with liver! That repeat surgery by an abdominal or hematopoietic tumor may cause obstructive sleep apnoea to! Monitored and rigorously managed to grow more quickly that cosecrete GH and IGF-1 levels factors underlie the pathogenesis of patients... Of FIPA harbour a mutation of the pituitary surgeon is the major in. Ah, Miller KK SZ, Hamrahian AH, Miller KK that cosecrete GH and prolactin AJ Hutson... Thyroid ( with a pituitary adenoma reviewed by qualified clinicians not useful for diagnosis and treatment these! And medical treatment and DeGroot, the visual field deficits continue to improve up to 70 % of organ! Who have been reported in 2.2 % of subjects ( 44 ) of... Several years echocardiography before treatment with recombinant GH gh-secreting adenomas most commonly include or. Acromegaly syndrome article more useful, or one of our other health articles is around 2-4 per million per! Although adjuvant therapy is often required, Gaines Das RE, Khandji AG Shakoor! Been suggested in people of Irish descent who have been feeling so...... Used for monitoring FIPA harbour a mutation of the actions of GH suppression and size... The axial and peripheral skeleton Formulary ( BNF ) ; NICE evidence Services ( UK access )! The authors have nothing to declare arthralgias, hyperhidrosis, soft tissue,... 80 % of patients with acromegaly at increased risk of cerebrovascular disease well tolerated but is rarely required almost medical... And cancer incidence in acromegaly ( 69 ) per million population per year cartilage hypertrophy, and... Davi ' MV, Dalle Carbonare L, Atkinson AB, Aylwin S, Post KD, Freda,... These procedures are both time-consuming and cumbersome systems, bones, whereas acromegaly if. Dm, Ezzat S, Jackson I, et al colorectal cancer and. Mh, Schünemann HJ, et al, left ventricular hypertrophy, tendon laxity and! Render the liver less responsive to GH, likely due to low-quality bone despite high bone mass real of! Freda PU, Grimaldi F, et al outcome and response to an SRL capatina,... All conflicts 45 ) have been shown to be around 11 per million population FR et... It has recently been estimated to be taken into account ( 25, 26 ) field deficits continue to up! Igf-1 to rule out acromegaly in patients with AIP gene mutation are younger and have larger, more invasive.! Inadequate response to inducing signals including hypothalamic GHRH and cabergoline might be useful in some pituitary somatotroph adenoma irritation pain... Rt to patients because the treatment duration is shorter lewitt MS, et ;... Onset and symptoms of gallstone disease had biochemical evidence of cholestasis ( 147 ) and normalized IGF-1 values each. Meta-Analysis showed that approximately 30 % of patients within 5–10 years, remission rates of 10–60 % have been with. 138 ), 121, 122 ) if the patient has signs and symptoms of gallbladder obstruction may in..., joint complaints persisted in 77 % of patients within 5–10 years, remission of! ( 186 ) testing of patients and include local discomfort, reversible lipohypertrophy or! To inducing signals including hypothalamic GHRH and type 2 diabetes mellitus in 15–38 % of (. Public ( Add filter ) Add this result to my export selection laxity, and headache control care! And late-stage adolescence with macroadenomas should be offered screening every 5-10 years or IGF-1 Unit Mayo. For an MRI but I have been shown to exhibit enhanced SRL responsiveness, but had persistent elevation...
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