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Škorić Polovina T, Režić T, Kraljević I, Heinrich Z, Solak M, Dušek T, Balaško A, Zibar Tomšić K, Kaštelan D. Gamma-knife radiosurgery in acromegaly: the results from the Croatian acromegaly registry. Br J Neurosurg 2024; 38:833-837. [PMID: 34528850 DOI: 10.1080/02688697.2021.1976393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 07/02/2021] [Accepted: 08/31/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE The aim of our study was to evaluate the efficacy and safety of Leksell gamma-knife radiosurgery in the treatment of residual growth hormone-secreting pituitary adenomas after the surgery. MATERIALS AND METHODS We conducted a retrospective analysis of 23 acromegaly patients treated with gamma-knife radiosurgery between 1996 and 2019. The therapeutic success of radiosurgery was defined as IGF-1 normalization without suppressive medication (complete response) or as IGF-1 normalization with medication (partial response). RESULTS The median follow-up was 57 (10-198) months. Complete response was achieved in 11 patients (47.8%) with actuarial remission rates of 17.4%, 26.1%, 39.1% and 47.8% at 1, 2, 4, and 7 years, respectively. The median time to complete the response was 21 (6-85) months. Partial response was achieved in another nine patients (39.1%) after a median time of 48 (6-144) months from radiosurgery. Patients who achieved complete remission had significantly lower IGF-1 levels before radiosurgery (p = 0.016) as well as smaller tumour volume (p = 0.016) and radiologically less invasive tumours (p = 0.022) in comparison to patients who did not achieve IGF-1 normalization. Tumour growth control after radiosurgery was established in all patients. During the follow-up, new hormone deficiencies were found in seven patients (30.4%) which corresponds to the incidence of one new case of hypopituitarism per 7.1 patient years. CONCLUSIONS Gamma-knife radiosurgery offers endocrine remission and tumour growth control in a substantial proportion of patients with GH-secreting adenomas. Given the high cost of life-long medical treatment and a moderate risk of radiation-induced side effects, radiosurgery for growth hormone-secreting pituitary adenomas should be considered in all patients with residual tumours.
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Affiliation(s)
| | - Tanja Režić
- Clinical Hospital "Dubrava", Zagreb, Croatia
| | - Ivana Kraljević
- Department of Endocrinology, University Hospital Centre Zagreb, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Zdravko Heinrich
- Department of Stereotactic, Functional and Radio-neurosurgery, Clinic of Neurosurgery, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Mirsala Solak
- Department of Endocrinology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Tina Dušek
- Department of Endocrinology, University Hospital Centre Zagreb, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Annemarie Balaško
- Department of Endocrinology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Karin Zibar Tomšić
- Department of Endocrinology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Darko Kaštelan
- Department of Endocrinology, University Hospital Centre Zagreb, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
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Amodru V, Sahakian N, Piazzola C, Appay R, Graillon T, Cuny T, Morange I, Albarel F, Vermalle M, Regis J, Dufour H, Brue T, Castinetti F. Changes in multi-modality management of acromegaly in a tertiary centre over 2 decades. Pituitary 2024; 27:294-302. [PMID: 38521837 DOI: 10.1007/s11102-024-01387-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/16/2024] [Indexed: 03/25/2024]
Abstract
PURPOSE Acromegaly is a rare disease associated with chronic multisystem complications. New therapeutic strategies have emerged in the last decades, combining pituitary transsphenoidal surgery (TSS), radiotherapy or radiosurgery (RXT) and medical treatments. METHODS This retrospective monocentric study focused on presentation, management and outcome of acromegaly patients diagnosed between 2000 and 2020, still followed up in 2020, with a minimum follow-up of 1 year, and comparison of the first vs. second decade of the study. RESULTS 275 patients were included, 50 diagnosed before 2010 and 225 after 2010. 95% of them had normal IGF-1 levels (with or without treatment) at the last follow-up. Transsphenoidal surgery was more successful after 2010 (75% vs. 54%; p < 0.01), while tumor characteristics remained the same over time. The time from first treatment to biochemical control was shorter after 2010 than before (8 vs. 16 months; p = 0.03). Since 2010, RT was used less frequently (10% vs. 32%; p < 0.01) but more rapidly after surgery (26 vs. 53 months; p = 0.03). In patients requiring anti-secretory drugs after TSS, the time from first therapy to biochemical control was shorter after 2010 (16 vs. 29 months; p < 0.01). Tumor size, tumor invasiveness, baseline IGF-1 levels and Trouillas classification were identified as predictors of remission. CONCLUSION The vast majority of patients with acromegaly now have successful disease control with a multimodal approach. They reached biochemical control sooner in the most recent half of the study period. Future work should focus on those patients who are still uncontrolled and on the sequelae of the disease.
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Affiliation(s)
- V Amodru
- Marseille Medical Genetics, Institut MarMaRa, INSERM, UMR1251, Aix Marseille Univ, Marseille, France
- Department of Endocrinology, Hôpital La Conception, Service d'Endocrinologie, Institut MarMaRa, APHM, Aix Marseille Univ, 147 Boulevard Baille, 13005, Marseille, France
| | - N Sahakian
- Marseille Medical Genetics, Institut MarMaRa, INSERM, UMR1251, Aix Marseille Univ, Marseille, France
- Department of Endocrinology, Hôpital La Conception, Service d'Endocrinologie, Institut MarMaRa, APHM, Aix Marseille Univ, 147 Boulevard Baille, 13005, Marseille, France
| | - C Piazzola
- Marseille Medical Genetics, Institut MarMaRa, INSERM, UMR1251, Aix Marseille Univ, Marseille, France
- Department of Endocrinology, Hôpital La Conception, Service d'Endocrinologie, Institut MarMaRa, APHM, Aix Marseille Univ, 147 Boulevard Baille, 13005, Marseille, France
| | - R Appay
- Department of Pathology, Hôpital La Timone, APHM, Aix Marseille Univ, Marseille, France
| | - T Graillon
- Department of Endocrinology, Hôpital La Conception, Service d'Endocrinologie, Institut MarMaRa, APHM, Aix Marseille Univ, 147 Boulevard Baille, 13005, Marseille, France
- Department of Neurosurgery, Hôpital La Timone, APHM, Aix Marseille Univ, Marseille, France
| | - T Cuny
- Marseille Medical Genetics, Institut MarMaRa, INSERM, UMR1251, Aix Marseille Univ, Marseille, France
- Department of Endocrinology, Hôpital La Conception, Service d'Endocrinologie, Institut MarMaRa, APHM, Aix Marseille Univ, 147 Boulevard Baille, 13005, Marseille, France
| | - I Morange
- Marseille Medical Genetics, Institut MarMaRa, INSERM, UMR1251, Aix Marseille Univ, Marseille, France
- Department of Endocrinology, Hôpital La Conception, Service d'Endocrinologie, Institut MarMaRa, APHM, Aix Marseille Univ, 147 Boulevard Baille, 13005, Marseille, France
| | - F Albarel
- Marseille Medical Genetics, Institut MarMaRa, INSERM, UMR1251, Aix Marseille Univ, Marseille, France
- Department of Endocrinology, Hôpital La Conception, Service d'Endocrinologie, Institut MarMaRa, APHM, Aix Marseille Univ, 147 Boulevard Baille, 13005, Marseille, France
| | - M Vermalle
- Marseille Medical Genetics, Institut MarMaRa, INSERM, UMR1251, Aix Marseille Univ, Marseille, France
- Department of Endocrinology, Hôpital La Conception, Service d'Endocrinologie, Institut MarMaRa, APHM, Aix Marseille Univ, 147 Boulevard Baille, 13005, Marseille, France
| | - J Regis
- Department of Functional Neurosurgery, Hôpital La Timone, APHM, Aix Marseille Univ, Marseille, France
| | - H Dufour
- Department of Endocrinology, Hôpital La Conception, Service d'Endocrinologie, Institut MarMaRa, APHM, Aix Marseille Univ, 147 Boulevard Baille, 13005, Marseille, France
- Department of Neurosurgery, Hôpital La Timone, APHM, Aix Marseille Univ, Marseille, France
| | - T Brue
- Marseille Medical Genetics, Institut MarMaRa, INSERM, UMR1251, Aix Marseille Univ, Marseille, France
- Department of Endocrinology, Hôpital La Conception, Service d'Endocrinologie, Institut MarMaRa, APHM, Aix Marseille Univ, 147 Boulevard Baille, 13005, Marseille, France
| | - F Castinetti
- Marseille Medical Genetics, Institut MarMaRa, INSERM, UMR1251, Aix Marseille Univ, Marseille, France.
- Department of Endocrinology, Hôpital La Conception, Service d'Endocrinologie, Institut MarMaRa, APHM, Aix Marseille Univ, 147 Boulevard Baille, 13005, Marseille, France.
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Falch CM, Dupont AK, Olarescu NC, Wiedmann M, Dahlberg D, Bollerslev J, Berg-Johnsen J, Heck A. Long-term control of acromegaly after pituitary surgery in South-Eastern Norway. Acta Neurochir (Wien) 2023; 165:3003-3010. [PMID: 37665404 PMCID: PMC10542199 DOI: 10.1007/s00701-023-05772-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 08/17/2023] [Indexed: 09/05/2023]
Abstract
PURPOSE Sustained cure of acromegaly can only be achieved by surgery. Most growth hormone (GH) secreting pituitary adenomas are macroadenomas (≥ 10 mm) at diagnosis, with reported surgical cure rates of approximately 50%. Long-term data on disease control rates after surgery are limited. Our aim was to estimate short- and long-term rates of biochemical control after pituitary surgery in acromegaly and identify predictive factors. METHODS Patients operated for GH-secreting pituitary adenomas between 2005-2020 were included from the local pituitary registry (n = 178). Disease activity and treatment data were recorded at one-year (short-term) and five-year (long-term) postoperative follow-up. Biochemical control was defined as insulin-like growth factor 1 (IGF-1) ≤ 1.2 × upper limit of normal value. Multivariate regression models were used to identify factors potentially predicting biochemical control. RESULTS A total of 178 patients with acromegaly (median age at diagnosis 49 (IQR: 38-59) years, 46% women) were operated for a pituitary adenoma. Biochemical control was achieved by surgery in 53% at short-term and 41% at long-term follow-up, without additional treatment for acromegaly. Biochemical control rates by surgery were of same magnitude in paired samples (45% vs. 41%, p = 0.213) for short- and long-term follow-up, respectively. At short-term, 62% of patients with microadenomas and 51% with macroadenomas, achieved biochemical control. At long-term, the biochemical control rate was 58% for microadenomas and 37% for macroadenomas (p = 0.058). With adjunctive treatment, 82% achieved biochemical control at long-term. Baseline IGF-1 levels significantly predicted biochemical control by surgery at short-term (OR: 0.98 (95% CI: 0.96-0.99), p = 0.011), but not at long-term (OR: 0.76 (95% CI: 0.57-1.00), p = 0.053). CONCLUSION In unselected patients with acromegaly, the long-term biochemical control rate remains modest. Our findings indicate a need to identify patients at an earlier stage and improve therapeutic methods and surgical outcomes.
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Affiliation(s)
- Camilla M. Falch
- Section of Specialized Endocrinology, Department of Endocrinology, Oslo University Hospital, Postboks 4950 Nydalen, 0424 Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Postboks 1171 Blindern, 0318 Oslo, Norway
| | - Anne K. Dupont
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Postboks 1171 Blindern, 0318 Oslo, Norway
| | - Nicoleta C. Olarescu
- Section of Specialized Endocrinology, Department of Endocrinology, Oslo University Hospital, Postboks 4950 Nydalen, 0424 Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Postboks 1171 Blindern, 0318 Oslo, Norway
| | - Markus Wiedmann
- Department of Neurosurgery, Oslo University Hospital, Postboks 4950 Nydalen, 0424 Oslo, Norway
| | - Daniel Dahlberg
- Department of Neurosurgery, Oslo University Hospital, Postboks 4950 Nydalen, 0424 Oslo, Norway
| | - Jens Bollerslev
- Section of Specialized Endocrinology, Department of Endocrinology, Oslo University Hospital, Postboks 4950 Nydalen, 0424 Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Postboks 1171 Blindern, 0318 Oslo, Norway
| | - Jon Berg-Johnsen
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Postboks 1171 Blindern, 0318 Oslo, Norway
- Department of Neurosurgery, Oslo University Hospital, Postboks 4950 Nydalen, 0424 Oslo, Norway
| | - Ansgar Heck
- Section of Specialized Endocrinology, Department of Endocrinology, Oslo University Hospital, Postboks 4950 Nydalen, 0424 Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Postboks 1171 Blindern, 0318 Oslo, Norway
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Kerbel J, Cano-Zaragoza A, Espinosa-Dorado R, García de la Torre KE, Mercado M. Real World Data on the Epidemiology, Diagnosis, and Treatment of Acromegaly: A Registries-based Approach. Arch Med Res 2023; 54:102856. [PMID: 37481822 DOI: 10.1016/j.arcmed.2023.102856] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 07/05/2023] [Accepted: 07/11/2023] [Indexed: 07/25/2023]
Abstract
INTRODUCTION Despite the inherent heterogeneity of the information derived from national registries, they are a useful tool to investigate the epidemiological, clinical, biochemical and treatment outcome characteristics of low prevalence conditions such as acromegaly. Although the information provided by single-center experiences is more homogeneous, these studies usually comprise a limited number of patients and thus, frequently lack statistical power. AREAS COVERED Registry-based Information regarding the epidemiology, clinical presentation, biochemical and imaging diagnosis, as well as therapeutic outcome and mortality in acromegaly is critically analyzed. EXPERT OPINION By gathering data from multiple centers in a specific Country, these registries generate important insights into the real-life behavior of this condition, that should be considered, both, in international consensus meetings and in the design of local, Country-specific diagnostic and therapeutic strategies.
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Affiliation(s)
- Jacobo Kerbel
- Endocrine Research Unit, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Amayrani Cano-Zaragoza
- Endocrine Research Unit, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Rodrigo Espinosa-Dorado
- Endocrine Research Unit, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Keren-Enid García de la Torre
- Endocrine Research Unit, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Moisés Mercado
- Endocrine Research Unit, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico.
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Martins AF, Santos M, Rosário F. Caloric restriction as a possible pitfall for persistent acromegaly follow-up - case report. BMC Endocr Disord 2023; 23:68. [PMID: 36973824 PMCID: PMC10041756 DOI: 10.1186/s12902-023-01319-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 03/09/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND Acromegaly diagnosis is established when plasma levels of IGF-1 are increased and the Oral Glucose Tolerance Test (OGTT) with 75gr of glucose can't suppress Growth Hormone (GH) levels. These two parameters are also useful during follow-up, after surgical/radiologic therapy and/or during medical therapy. CASE PRESENTATION A 29-year-old woman was diagnosed with acromegaly after a severe headache. Previous amenorrhea and facial and acral changes were noticed. A pituitary macroadenoma was found, biochemical evaluation was in agreement with the suspected acromegaly and a transsphenoidal adenectomy was performed. As the disease recurred, a surgical reintervention and radiosurgery (Gamma Knife, 22 Gy) were necessary. No normalization of IGF-1 was achieved during three years after radiosurgery. Surprisingly, then, and although clinical features seemed getting worse, IGF-1 levels became consistently controlled to 0.3-0.8 times the upper limit of the reference range. Questioned, the patient referred that she was following an intermittent fasting dietary plan. However, based on the dietary questionnaire, she was found to be under severe caloric restriction. First OGTT (under caloric restriction) showed absence of GH suppression and an IGF-1 value of 234 ng/dL (Reference Range 76-286 ng/mL). A second OGTT, one month after an eucaloric diet was instituted, showed an increased IGF-1 of 294 ng/dL, maintaining an unsuppressed, yet less elevated, GH. CONCLUSIONS GHRH/GH/IGF-1 axis controls somatic growth. Regulation is complex, and nutrition status and feeding pattern have a recognized role. Like systemic inflammation or chronic liver disease, fasting and malnutrition decrease the expression of hepatic GH receptors, with consequent reduction of IGF-1 levels, through resistance to GH. This clinical report shows that caloric restriction may represent a pitfall in acromegaly follow-up.
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Affiliation(s)
- Ana Filipa Martins
- Endocrine Department, Hospital da Luz de Lisboa, Av Lusíada, Nr 100, 1500-650 Lisbon, Portugal
| | - Mónica Santos
- Nutrition Department, Hospital da Luz de Lisboa, Av Lusíada, Nr 100, 1500-650 Lisbon, Portugal
| | - Francisco Rosário
- Endocrine Department, Hospital da Luz de Lisboa, Av Lusíada, Nr 100, 1500-650 Lisbon, Portugal
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Hamodi Hamza S, Fadhel Ashoor Z, Mahdi Rahmah A. The presence of Neopterin in the sera of a sample of Iraqi acromegalic patients (Type 2 diabetics and nondiabetics). BIONATURA 2022. [DOI: 10.21931/rb/2022.07.01.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Back ground: Acromegaly is a rare endocrine disease; its incidence is 4-6 million per year, while its prevalence is 40-60 million per year. They are separating acromegaly from gigantism that occurs before growth plates are closed. Neopterin is a systemic adaptive immune activation biomarker produced upon interferon-gamma (IFN-γ) stimulation by monocyte-derived macrophages and dendritic cells. Eighty acromegalic patients (50% diabetic acromegalic and 50% nondiabetic acromegalic) and forty healthy control groups were enrolled in the study to find out the level of Neopterin and insulin-like growth factor-1 in the sera of the study population; the results showed both molecules (neopterin and Insulin-like growth factor-1 were found to be high in acromegalic subjects when there is concomitant diabetes, and insulin-like growth factor-1 correlates positively with total cholesterol and neopterin. At the same time, neopterin correlates positively with HbA1c. This study was aimed to find out the difference in neopterin level in diabetic acromegalic versus n0n-diabetic acromegalic patients;
Eighty acromegalic subjects were enrolled in across sectional study by measuring the neopterin level in the sera of diabetics and nondiabetics as 39 have diabetes while the remaining 41 patients are nondiabetic. Neopterin is high among diabetic acromegalic patients when compared with nondiabetic acromegalic subjects. Insulin-like growth factor-1 correlates positively with neopterin and total cholesterol; (4) Conclusions: Across sectional-study enrolling eighty acromegalic patients registered in the National Diabetes Center. Thus they were subdivided into two groups: - diabetic and nondiabetic the level of neopterin was found to be among diabetic versus nondiabetics.
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Biagetti B, Iglesias P, Villar-Taibo R, Moure MD, Paja M, Araujo-Castro M, Ares J, Álvarez-Escola C, Vicente A, Álvarez Guivernau È, Novoa-Testa I, Guerrero Perez F, Cámara R, Lecumberri B, García Gómez C, Bernabéu I, Manjón L, Gaztambide S, Cordido F, Webb SM, Menéndez-Torre EL, Díez JJ, Simó R, Puig-Domingo M. Factors associated with therapeutic response in acromegaly diagnosed in the elderly in Spain. Front Endocrinol (Lausanne) 2022; 13:984877. [PMID: 36187107 PMCID: PMC9523598 DOI: 10.3389/fendo.2022.984877] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 08/30/2022] [Indexed: 11/13/2022] Open
Abstract
CONTEXT Some reports suggest that acromegaly in elderly patients has a more benign clinical behavior and could have a better response to first-generation long-acting somatostatin receptor ligands (SRL). However, there is no specific therapeutic protocol for this special subgroup of patients. OBJECTIVE This study aimed at identifying predictors of response to SRL in elderly patients. DESIGN Multicentric retrospective nationwide study of patients diagnosed with acromegaly at or over the age of 65 years. RESULTS One-hundred and eighteen patients (34 men, 84 women, mean age at diagnosis 71.7 ± 5.4 years old) were included. Basal insulin-like growth factor type 1 (IGF-1) above the upper limit of normal (ULN) and growth hormone (GH) levels (mean ± SD) were 2.7 ± 1.4 and 11.0 ± 11.9 ng/ml, respectively. The mean maximal tumor diameter was 12.3 ± 6.4 mm, and up to 68.6% were macroadenoma. Seventy-two out of 118 patients (61.0%) underwent surgery as primary treatment. One-third of patients required first-line medical treatment due to a rejection of surgical treatment or non-suitability because of high surgical risk. After first-line surgery, 45/72 (63.9%) were in disease remission, and 16/34 (46.7%) of those treated with SRL had controlled disease. Patients with basal GH at diagnosis ≤6 ng/ml had lower IGF-1 levels and had smaller tumors, and more patients in this group reached control with SRL (72.7% vs. 33.3%; p < 0.04) [OR: 21.3, IC: 95% (2.4-91.1)], while male patients had a worse response [OR: 0.09, IC 95% (0.01-0.75)]. The predictive model curve obtained for SRL response showed an AUC of 0.82 CI (0.71-0.94). CONCLUSIONS The most frequent phenotype in newly diagnosed acromegaly in the elderly includes small adenomas and moderately high IGF-1 levels. GH at diagnosis ≤6 ng/ml and female gender, but not age per se, were associated with a greater chance of response to SRL.
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Affiliation(s)
- Betina Biagetti
- Endocrinology Department, Diabetes and Metabolism Research Unit, Vall d’Hebron University Hospital and Vall d’Hebron Research Institute (VHIR), Universidad Autónoma de Barcelona, Barcelona, Spain
- *Correspondence: Betina Biagetti, ; Manel Puig-Domingo,
| | - Pedro Iglesias
- Department of Endocrinology, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Rocío Villar-Taibo
- Endocrinology Department, University Hospital of Santiago de Compostela, Neoplasia and Differentiation of Endocrine Cells Group, Instituto de Investigación Sanitaria-IDIS (Health Research Institute), Santiago de Compostela, Spain
| | - María-Dolores Moure
- Endocrinology Department, Cruces University Hospital, Biocruces Bizkaia, Endo-European Reference Networks (ERN), Barakaldo, Spain
- Neoplasia and Differentiation of Endocrine Cells Group, Instituto de Investigación Sanitaria-IDIS (Health Research Institute), Santiago de Compostela, Spain
| | - Miguel Paja
- Department of Endocrinology, Hospital Universitario Basurto, Bilbao, Spain
| | - Marta Araujo-Castro
- Department of Endocrinology and Nutrition, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Jessica Ares
- Department of Endocrinology and Nutrition, Hospital Universitario Central de Asturias, Asturias, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Centro de Investigación Biomédica en Red Enfermedades Raras (CIBERER), Universidad de Oviedo, Oviedo, Spain
| | | | - Almudena Vicente
- Department of Endocrinology and Nutrition, Hospital Universitario de Toledo, Toledo, Spain
| | - Èlia Álvarez Guivernau
- Department of Endocrinology, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Hospital Sant Pau, Institut d’Investigacions Biomèdiques (IIB) SPau, Barcelona, Spain
- Department of Medicine, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Iria Novoa-Testa
- Endocrinology and Nutrition Department, A Coruña University Hospital and A Coruña University, A Coruña, Spain
| | - Fernando Guerrero Perez
- Department of Endocrinology, Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Rosa Cámara
- Endocrinology and Nutrition Service, La Fe University Hospital, Valencia, Spain
| | - Beatriz Lecumberri
- Department of Endocrinology, Hospital Universitario La Paz, Madrid, Spain
| | - Carlos García Gómez
- Department of Endocrinology, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Ignacio Bernabéu
- Endocrinology Department, University Hospital of Santiago de Compostela, Neoplasia and Differentiation of Endocrine Cells Group, Instituto de Investigación Sanitaria-IDIS (Health Research Institute), Santiago de Compostela, Spain
| | - Laura Manjón
- Department of Endocrinology and Nutrition, Hospital Universitario Central de Asturias, Asturias, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Centro de Investigación Biomédica en Red Enfermedades Raras (CIBERER), Universidad de Oviedo, Oviedo, Spain
| | - Sonia Gaztambide
- Endocrinology Department, Cruces University Hospital, Biocruces Bizkaia, Endo-European Reference Networks (ERN), Barakaldo, Spain
- Health Research Institute, Universidad País Vasco - Euskal Herriko Unibertsitatea (UPV-EHU), Centro de Investigación Biomédica en Red Enfermedades Raras (CIBERER), Centro de Investigación Biomédica en Red Diabetes y Enfermedades Metabólicas (CIBERDEM), Barakaldo, Spain
| | - Fernando Cordido
- Endocrinology and Nutrition Department, A Coruña University Hospital and A Coruña University, A Coruña, Spain
| | - Susan M. Webb
- Department of Endocrinology, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Hospital Sant Pau, Institut d’Investigacions Biomèdiques (IIB) SPau, Barcelona, Spain
- Department of Medicine, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Edelmiro Luis Menéndez-Torre
- Department of Endocrinology and Nutrition, Hospital Universitario Central de Asturias, Asturias, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Centro de Investigación Biomédica en Red Enfermedades Raras (CIBERER), Universidad de Oviedo, Oviedo, Spain
| | - Juan J. Díez
- Department of Endocrinology, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
- Department of Medicine, Instituto de Investigación Sanitaria Puerta de Hierro Segovia de Arana, Universidad Autónoma de Madrid, Majadahonda, Spain
| | - Rafael Simó
- Endocrinology Department, Diabetes and Metabolism Research Unit, Vall d’Hebron University Hospital and Vall d’Hebron Research Institute (VHIR), Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Manel Puig-Domingo
- Endocrinology and Nutrition Service, Germans Trias Hospital and Research Institute, Autonomous University of Barcelona, Badalona, Spain
- *Correspondence: Betina Biagetti, ; Manel Puig-Domingo,
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8
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Castellanos-Bueno R, Abreu-Lomba A, Buitrago-Gómez N, Patiño-Arboleda M, Pantoja-Guerrero D, Valenzuela-Rincón A, Arenas-Quintero HM, Franco-Betancur HI, Castellanos-Pinedo A, Movilla-Castro D, Ocampo-Chaparro JM, Reyes-Ortiz CA, Pinzón-Tovar A. Clinical and epidemiological characteristics, morbidity and treatment based on the registry of acromegalic patients in Colombia: RAPACO. Growth Horm IGF Res 2021; 60-61:101425. [PMID: 34416544 DOI: 10.1016/j.ghir.2021.101425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 08/07/2021] [Accepted: 08/09/2021] [Indexed: 10/20/2022]
Abstract
AIMS Describe the local characteristics, methodology and results of the registry of acromegalic patients in Colombia (RAPACO). METHODS Multicenter, retrospective study based on the registry of acromegalic patients in Colombia: RAPACO. The data collected included: demographics, diagnosis, approximate time of disease evolution, data on weight, height, body mass index (BMI), neck circumference (NC) abdominal circumference (AC) hip circumference (HC) and waist/hip ratio (WHR); clinical and biochemical data at the time of diagnosis, etiology, immunohistochemistry of the tumor and information related to types of treatment. Descriptive analytics were employed. RESULTS A total of 201 patients (60% females) with an average age at registration of 49.5 ± 14.6 years and an average time of evolution of the disease of 6.96 ± 4.5 years. Average weight was 75.1 Kg ± 12.98, with an average BMI of 28.11 ± 4.33. The most frequent symptoms mentioned at the time of diagnosis were extremity enlargement and headache. The most frequent comorbidity was arterial hypertension in 50.3% of the cases. 78.6% of cases were caused by macroadenoma. 80.1% received surgical treatment, 77.6% were under medical treatment, of which 95.7% were receiving somatostatin analogues. 26.4% of patients were treated with radiation therapy. Of the patients who received any type of clinical treatment, only 2.5% reported biochemical control at registration. CONCLUSION It is important to recognize the local epidemiological, clinical, biochemical and treatment characteristics in order to assist in further understanding this pathology to implement local measures to improve both the quality of life as well as the prognosis of the patients diagnosed.
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Affiliation(s)
| | - Alín Abreu-Lomba
- Universidad Libre, Cali - Colombia, GIMI1 (Grupo interinstitucional de Medicina Interna 1), Department of Endocrinology, Clínica Imbanaco grupo QuironSalud, Cali, Colombia; Universidad Libre, GIMI1 (Grupo interinstitucional de Medicina Interna 1), Department of Internal Medicine, Cali, Colombia.
| | - Nathalia Buitrago-Gómez
- Universidad Libre, GIMI1 (Grupo interinstitucional de Medicina Interna 1), Department of Internal Medicine, Cali, Colombia.
| | - Marcela Patiño-Arboleda
- Universidad Libre, GIMI1 (Grupo interinstitucional de Medicina Interna 1), Department of Internal Medicine, Cali, Colombia.
| | | | - Alex Valenzuela-Rincón
- Universidad del Rosario Bogotá, Department of Endocrinology Fundación Cardioinfantil, Colombia.
| | - Henry M Arenas-Quintero
- Universidad tecnológica de Pereira, Department of Endocrinology Clínica Comfamiliar Pereira, Colombia.
| | | | - Alejandro Castellanos-Pinedo
- Universidad del Sinú, Monteria, Colombia, Department of Endocrinology Hospital San Jerónimo, Montería, Colombia.
| | | | - José M Ocampo-Chaparro
- Universidad Libre, GIMI1 (Grupo interinstitucional de Medicina Interna 1), Department of Internal Medicine, Cali, Colombia; Universidad del Valle, Facultad de Salud, Departamento Medicina Familiar, Cali, Colombia.
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9
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Dal J, Skov BG, Andersen M, Feldt-Rasmussen U, Feltoft CL, Karmisholt J, Nielsen EH, Dekkers OM, Jørgensen JOL. Sex differences in acromegaly at diagnosis: A nationwide cohort study and meta-analysis of the literature. Clin Endocrinol (Oxf) 2021; 94:625-635. [PMID: 33306249 DOI: 10.1111/cen.14392] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 11/06/2020] [Accepted: 12/03/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Data on sex differences in acromegaly at the time of diagnosis vary considerably between studies. DESIGN A nationwide cohort study including all incident cases of acromegaly (1978-2010, n = 596) and a meta-analysis on sex differences in active acromegaly (40 studies) were performed. METHOD Sex-dependent differences in prevalence, age at diagnosis, diagnostic delay, pituitary adenoma size, insulin-like growth factor 1 (IGF-I) and growth hormone (GH) concentrations were estimated. RESULTS The cohort study identified a balanced gender distribution (49.6% females) and a comparable age (years) at diagnosis (48.2 CI95% 46.5-49.8 (males) vs. 47.2 CI95% 45.5-48.9 (females), p = 0.4). The incidence rate significantly increased during the study period (R2 = 0.42, p < 0.01) and the gender ratio (F/M) changed from female predominance to an even ratio (SR: 1.4 vs. 0.9, p = 0.03). IGF-ISDS was significantly lower in females compared to males, whereas neither nadir GH nor pituitary adenoma size differed between males and females. In the meta-analysis, the weighted percentage female was 53.3% (CI95% 51.5-55.2) with considerable heterogeneity (I2 = 85%) among the studies. The mean age difference at diagnosis between genders was 3.1 years (CI95% 1.9-4.4), and the diagnostic delay was longer in females by 0.9 years (CI95% -0.4 to 2.1). Serum IGF-I levels were significantly lower in female patients, whereas nadir GH, and pituitary adenoma size were comparable. CONCLUSION There are only a minor sex differences in the epidemiology of acromegaly at the time of diagnosis except that female patients are slightly older and exhibit lower IGF-I concentrations and a longer diagnostic delay.
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Affiliation(s)
- Jakob Dal
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
- Steno Diabetes Center North Jutland, Aalborg, Denmark
| | - Benedikte G Skov
- Department of Endocrinology, Aarhus University Hospital, Aarhus C, Denmark
| | - Marianne Andersen
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
| | - Ulla Feldt-Rasmussen
- Department of Endocrinology and Metabolism, National University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Claus L Feltoft
- Department of Endocrinology, Herlev University Hospital, Herlev, Denmark
| | - Jesper Karmisholt
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
- Clinical Institute, Aalborg University, Aalborg, Denmark
| | - Eigil H Nielsen
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
| | - Olaf M Dekkers
- Department of Clinical Epidemiolgy and Metabolism, Leiden University Medical Centre, Leiden, The Netherlands
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10
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Nista F, Corica G, Castelletti L, Khorrami K, Campana C, Cocchiara F, Zoppoli G, Prior A, Rossi DC, Zona G, Ferone D, Gatto F. Clinical and Radiological Predictors of Biochemical Response to First-Line Treatment With Somatostatin Receptor Ligands in Acromegaly: A Real-Life Perspective. Front Endocrinol (Lausanne) 2021; 12:677919. [PMID: 34025586 PMCID: PMC8139627 DOI: 10.3389/fendo.2021.677919] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 04/19/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND First-generation somatostatin receptor ligands (fg-SRLs) represent the first-line medical treatment for acromegaly, recommended in patients with persistent disease after neurosurgery, or when surgical approach is not feasible. Despite the lack of strong recommendations from guidelines and consensus statements, data from national Registries report an increasing use of medical therapy as first-line treatment in acromegaly. OBJECTIVE We retrospectively evaluated the potential role of a large number of clinical and radiological parameters in predicting the biochemical response to 6-month treatment with fg-SRLs, in a cohort of naïve acromegaly patients referred to a single tertiary center for pituitary diseases. METHODS Univariable and multivariable logistic regression and linear regression analyses were performed. Biochemical response was defined based on IGF-1 levels, represented as both categorical (tight control, control, >50% reduction) and continuous (linear % reduction) variables. RESULTS Fifty-one patients (33 females, median age 57 years) were included in the study. At univariable logistic regression analysis, we found that younger age (≤ 40 years; OR 0.04, p=0.045) and higher BMI (OR 0.866, p=0.034) were associated with a lower chance of achieving >50% IGF-1 reduction. On the contrary, higher IGF-1 xULN values at diagnosis (OR 2.304, p=0.007) and a T2-hypointense tumor (OR 18, p=0.017) were associated with a significantly higher likelihood of achieving >50% IGF-1 reduction after SRL therapy. Of note, dichotomized age, IGF1 xULN at diagnosis, and T2-hypointense signal of the tumor were retained as significant predictors by our multivariable logistic regression model. Furthermore, investigating the presence of predictors to the linear % IGF-1 reduction, we found a negative association with younger age (≤ 40 years; β -0.533, p<0.0001), while a positive association was observed with both IGF-1 xULN levels at diagnosis (β 0.330, p=0.018) and the presence of a T2-hypointense pituitary tumor (β 0.466, p=0.019). All these variables were still significant predictors at multivariable analysis. CONCLUSIONS Dichotomized age, IGF-1 levels at diagnosis, and tumor T2-weighted signal are reliable predictors of both >50% IGF-1 reduction and linear % IGF-1 reduction after 6 month fg-SRL treatment in naïve acromegaly patients. These parameters should be considered in the light of an individualized treatment for acromegaly patients.
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Affiliation(s)
- Federica Nista
- Endocrinology Unit, Department of Internal Medicine and Center of Excellence for Biomedical Research, University of Genoa, Genoa, Italy
| | - Giuliana Corica
- Endocrinology Unit, Department of Internal Medicine and Center of Excellence for Biomedical Research, University of Genoa, Genoa, Italy
| | | | - Keyvan Khorrami
- Endocrinology Unit, Department of Internal Medicine and Center of Excellence for Biomedical Research, University of Genoa, Genoa, Italy
| | - Claudia Campana
- Endocrinology Unit, Department of Internal Medicine and Center of Excellence for Biomedical Research, University of Genoa, Genoa, Italy
| | - Francesco Cocchiara
- Endocrinology Unit, Department of Internal Medicine and Center of Excellence for Biomedical Research, University of Genoa, Genoa, Italy
| | - Gabriele Zoppoli
- Department of Internal Medicine, University of Genoa and IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Alessandro Prior
- Division of Neurosurgery, Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Diego Criminelli Rossi
- Division of Neurosurgery, Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Gianluigi Zona
- Division of Neurosurgery, Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Diego Ferone
- Endocrinology Unit, Department of Internal Medicine and Center of Excellence for Biomedical Research, University of Genoa, Genoa, Italy
- Endocrinology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- *Correspondence: Diego Ferone, orcid.org/0000-0002-1410-6143
| | - Federico Gatto
- Endocrinology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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11
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AlMalki MH, Ahmad MM, Buhary BM, Aljawair R, Alyamani A, Alhozali A, Alshahrani A, Alzahrani S, Nasser T, Alzahrani W, Raef H, Aldawish M, Elkhzaimy A. Clinical features and therapeutic outcomes of patients with acromegaly in Saudi Arabia: a retrospective analysis. Hormones (Athens) 2020; 19:377-383. [PMID: 32388630 DOI: 10.1007/s42000-020-00191-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 03/22/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND Acromegaly is a rare disease resulting in clinical sequelae with significant morbidity and mortality due to the central tumor mass effect and prolonged growth hormone (GH) hypersecretion. OBJECTIVES The goal is to describe the epidemiology, clinical features, presence of comorbidities, and treatment outcomes of acromegaly in Saudi Arabia. METHODS Data was collected through a retrospective review of the charts of all patients diagnosed with acromegaly from nine major hospitals in Saudi Arabia over a period of more than 25 years. RESULTS A total of 195 patients (116 males and 79 females), with a mean age at diagnosis of 43 ± 12 (males) and 46 ± 14 years (females), from nine major hospitals were identified and included in the analysis. All cases were caused by pituitary adenomas, of which 92.4% were macroadenomas. Headache, coarse facial features, acral growth, and sweating/oily skin were by far the most frequent presenting complaints. The most common comorbidities were diabetes mellitus (51.7%), followed by hypertension (50%) and visual field defect (30.5%). The vast majority (95%) of patients were treated surgically (98%). Twenty-four percent also received radiotherapy, and 74.4% received medical therapy. When stringent criteria were applied for assessment of outcomes of therapy, 28.7% of the patients were cured and 30.1% had their disease under control, while 28.7% were found to have active disease despite receiving multimodal therapy. CONCLUSIONS Our findings highlight the need for a national acromegaly registry to enable early identification, evaluation, and selection of the best therapeutic approaches to improve the outcome and remission rate of the disease.
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Affiliation(s)
- Mussa Hussain AlMalki
- Obesity, Endocrine, and Metabolism Center. King Fahad Medical City, Riyadh, Saudi Arabia.
- King Abdul Aziz Medical City, College of Medicine, King Saud bin Abdul Aziz University for Health Sciences, Riyadh, Saudi Arabia.
| | - Maswood M Ahmad
- Obesity, Endocrine, and Metabolism Center. King Fahad Medical City, Riyadh, Saudi Arabia
| | - Badurudeen M Buhary
- Obesity, Endocrine, and Metabolism Center. King Fahad Medical City, Riyadh, Saudi Arabia
| | - Rashid Aljawair
- Department of Endocrinology, King Fahad Military & Medical Complex, Dhahran, Saudi Arabia
| | - Arwa Alyamani
- Department of Endocrinology, King Abdullah Medical City, Makkah, Saudi Arabia
- Department of Medicine, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Amani Alhozali
- Department of Medicine, King Abdul Aziz University Hospital, Jeddah, Saudi Arabia
| | - Awad Alshahrani
- King Abdul Aziz Medical City, College of Medicine, King Saud bin Abdul Aziz University for Health Sciences, Riyadh, Saudi Arabia
- Department of Medicine, Ministry of National Guard Health Affair, Riyadh, Saudi Arabia
| | - Saud Alzahrani
- Department of Medicine, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Tariq Nasser
- King Abdul Aziz Medical City, College of Medicine, King Saud bin Abdul Aziz University for Health Sciences, Riyadh, Saudi Arabia
- Department of Medicine, Ministry of National Guard Health Affair, Jeddah, Saudi Arabia
| | - Wael Alzahrani
- Department of Endocrinology, Prince Sultan Medical City, Riyadh, Saudi Arabia
| | - Hussain Raef
- Department of Medicine, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Mohamed Aldawish
- Department of Endocrinology, Prince Sultan Medical City, Riyadh, Saudi Arabia
| | - Aishah Elkhzaimy
- Department of Medicine, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
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12
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Belaya ZE, Golounina OO, Rozhinskaya LY, Melnichenko GA, Isakov MА, Lutsenko AS, Alekseeva T, Zenkova TS, Przhiyalkovskaya EG, Panyushkina GM, Ilukhina OB, Ivanova EI, Krishtal EA, Vachygova AA, Pigarova EA, Dzeranova LK, Marova EI, Arapova SD, Mamedova EO, Grebennikova TA, Antsiferov MB, Dreval AV, Dedov II. Epidemiology, clinical manifestations and efficiency of different methods of treatment of acromegaly according to the United Russian Registry of Patients with Pituitary Tumors. ACTA ACUST UNITED AC 2020; 66:93-103. [DOI: 10.14341/probl10333] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 03/25/2020] [Accepted: 04/08/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND: The registry is the main source of information about patients with acromegaly for assessing the quality of medical care, effectiveness of treatment, determining the compliance of real clinical practice with existing standards and patient management protocols.
AIMS: To evaluate epidemiological, demographic and clinical characteristics of acromegaly in Russian Federation and effectiveness of treatment modalities.
MATERIALS AND METHODS: The object of the study was the database of the united Russian registry of patients with pituitary tumors with specific analysis of patients with acromegaly only. We analyzed the data of 4114 patients with acromegaly stored on the online system in February 2019.
RESULTS: Based on the data 32% of patients had complete clinical and laboratory remission of acromegaly; the percentage of patients with no remission was 68%, among them 22.5% had significant improvements in clinical symptoms and a decrease in growth hormone (GH) and insulin-like growth factor-1 (IGF-1) without IGF-1 normalization. The average age of patients at the onset of the disease was 42.7 years and at diagnosis 45.8 years. The ratio of men to women was 1:2.6. In patients with acromegaly hypopituitarism was registered in 14.7% of cases and among them hypothyroidism (66%) and hypogonadism (52%) were registered more often. Among other complications the leading were diabetes mellitus (15.7%) and acromegalic arthropathy (15%). The proportion of patients receiving neurosurgical treatment increased from 35.7% to 49.6% in 20122019; the portion of patients undergoing radiation therapy decreased significantly from 17.7% in 2012 to 0.8% in 2019. Remission was achieved in 40.47% after neurosurgery and 28.95% after medical treatment as a first line therapy p0.01. The number of patients receiving medical treatment at the time of the study was 1209. Among them 51% of patients treated with long-acting lanreotide and 24% receiving long-acting octreotide achieved remission (p0.0001)
CONCLUSIONS: The remission rate of acromegaly remains suboptimal despite increased surgical activity, which corresponds to global trends. Long-acting lanreotide was significantly superior versus long-acting octreotide in the rate of acromegaly remission, which does not correspond with clinical trials.
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13
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Keskin Ç, Demir Ö, Karcı AÇ, Berker D, Cantürk Z, Yaylali GF, Topsakal Ş, Ersoy R, Bayram F, Ertörer ME, Bozkırlı E, Haydardedeoğlu F, Dilekçi ENA, Ay SA, Cansu GB, Şahin M, Emral R, Çorapçıoğlu D. The acromegaly registry of ten different centers in Turkey. Growth Horm IGF Res 2020; 53-54:101322. [PMID: 32417639 DOI: 10.1016/j.ghir.2020.101322] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 04/15/2020] [Accepted: 04/24/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To describe biochemical and clinical features, and therapeutic outcomes of acromegaly patients in Turkey. METHODS Retrospective multicenter epidemiological study of 547 patients followed in 10 centers of the Turkish Acromegaly registry. RESULTS A total of 547 acromegaly patients (55% female) with a median age of 41 was included in this study. Majority of patients had a macroadenoma (78%). Transsphenoidal surgery was performed as primary treatment in 92% of the patients (n = 503). Surgical remission rate was 39% (197/503) in all operated patients. Overall disease control was achieved in 70% of patients. Remission group were significantly older than non-remission group (p = .002). Patients with microadenomas had significantly higher remission rates than patients with macroadenomas (p < .001). Patients with microadenomas were significantly older at the time of diagnosis when compared to patients with macroadenomas (p < .001). Preoperative growth hormone (GH) and insulin-like growth factor 1 (IGF-1) levels were significantly lower in the remission group (p < .001). Initial IGF-1 and GH levels were significantly higher in macroadenomas compared to microadenomas (p < .001). Medical treatment was administered as a second-line treatment (97%) in almost all patients without remission. Radiotherapy was preferred in 21% of the patients mostly as a third line treatment. CONCLUSIONS This is one of the largest real life studies evaluating the epidemiological characteristics and treatment outcomes of patients with acromegaly who were followed in different centers in Turkey. Transsphenoidal surgery in the treatment of acromegaly still remains the most valid method. Medical treatment options may improve long-term disease outcomes in patients who cannot be controlled with surgical treatment (up to 70%).
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Affiliation(s)
- Çağlar Keskin
- Ankara University, Faculty of Medicine, Department of Endocrinology and Metabolic Diseases, Ankara, Turkey.
| | - Özgür Demir
- Ankara University, Faculty of Medicine, Department of Endocrinology and Metabolic Diseases, Ankara, Turkey
| | - Alper Çağrı Karcı
- Ankara Numune Training and Research Hospital, Department of Endocrinology and Metabolic Diseases, Ankara, Turkey
| | - Dilek Berker
- Ankara Numune Training and Research Hospital, Department of Endocrinology and Metabolic Diseases, Ankara, Turkey
| | - Zeynep Cantürk
- Kocaeli University, Faculty of Medicine, Department of Endocrinology and Metabolic Diseases, Kocaeli, Turkey
| | - Güzin Fidan Yaylali
- Pamukkale University, Faculty of Medicine, Department of Endocrinology and Metabolic Diseases, Denizli, Turkey
| | - Şenay Topsakal
- Pamukkale University, Faculty of Medicine, Department of Endocrinology and Metabolic Diseases, Denizli, Turkey
| | - Reyhan Ersoy
- Yıldırım Beyazıt University, Faculty of Medicine, Department of Endocrinology and Metabolic Diseases, Ankara, Turkey
| | - Fahri Bayram
- Erciyes University, Faculty of Medicine, Department of Endocrinology and Metabolic Diseases, Kayseri, Turkey
| | - Melek Eda Ertörer
- Başkent University, Adana Dr. Turgut Noyan Training and Research Hospital, Department of Endocrinology and Metabolic Diseases, Adana, Turkey
| | - Emre Bozkırlı
- Başkent University, Adana Dr. Turgut Noyan Training and Research Hospital, Department of Endocrinology and Metabolic Diseases, Adana, Turkey
| | - Filiz Haydardedeoğlu
- Başkent University, Adana Dr. Turgut Noyan Training and Research Hospital, Department of Endocrinology and Metabolic Diseases, Adana, Turkey
| | - Esra Nur Ademoğlu Dilekçi
- Abant İzzet Baysal University, Faculty of Medicine, Department of Endocrinology and Metabolic Diseases, Bolu, Turkey
| | - Seyid Ahmet Ay
- GATA Haydarpaşa Training Hospital, Department of Endocrinology and Metabolic Diseases, İstanbul, Turkey
| | - Güven Barış Cansu
- Eskişehir Yunus Emre Hospital, Department of Endocrinology and Metabolic Diseases, Eskişehir, Turkey
| | - Mustafa Şahin
- Ankara University, Faculty of Medicine, Department of Endocrinology and Metabolic Diseases, Ankara, Turkey
| | - Rıfat Emral
- Ankara University, Faculty of Medicine, Department of Endocrinology and Metabolic Diseases, Ankara, Turkey
| | - Demet Çorapçıoğlu
- Ankara University, Faculty of Medicine, Department of Endocrinology and Metabolic Diseases, Ankara, Turkey
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14
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Porto LB, Rosa JWC, Rosa JWC, Casulari LA, Zimmermann IR, Naves LA. Long-term real-life outcomes in a georrefered cohort of acromegalic patients in Brazil. Endocrine 2020; 68:390-398. [PMID: 32124262 DOI: 10.1007/s12020-020-02240-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 02/20/2020] [Indexed: 01/05/2023]
Abstract
PURPOSE Epidemiological data on acromegaly therapeutic outcomes in real-life conditions are scarce in Brazil. Information on the geographical accessibility to the dispensation of medicines and its impact on biochemical control is also poorly known. We aimed to describe the clinical outcomes of long-term therapy in patients with acromegaly at a referral medical centre in Brazil and to perform a spatial analysis of patients according to the distance from home to the drug-dispensing pharmacies aiming to evaluate its impact on biochemical control. METHODS Global retrospective data analysis of 111 patients followed at the University Hospital of Brasília from January 1980 to March 2015 was performed, as well as a separate review of 17 new cases operated on from April 2015 to June 2019 according to surgery results. Spatial analysis of patients under pharmacological treatment applying Geographic Information System (GIS) software (ArcGIS, ESRI, Redlands, CA) was performed. RESULTS Considering surgery alone, the cure rate was 23% from 1980 to 2015 and 29.4% from 2015 to 2019. In the long-term follow-up of the 111 patients from 1980 to 2015, 25.2% (n = 29) were cured, 40.6% (n = 44) presented controlled disease and 34.2% (n = 38) were biochemically uncontrolled after a period of follow-up of 8.9 ± 6.4 years. Biochemical control obtained in patients on pharmacological treatment (n = 76) was 58% (n = 44) after 5.8 ± 3.8 years. The distance from home to the drug-dispensing pharmacy did not influence biochemical control (p = 0.7616). CONCLUSIONS Most patients presented with disease under control. No evidence on the effect of the distance between home and drug-dispensing pharmacies on biochemical control was obtained.
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Affiliation(s)
- Lara Benigno Porto
- Unit of Endocrinology, Faculty of Medicine and Post-Graduation Program in Health Sciences, University of Brasilia, Brasilia, Brazil.
- Unit of Endocrinology of the Regional Hospital of Taguatinga and Research Centre of the Foundation for Education and Research in Health Sciences, Secretariat of Health of the Federal District, Brasilia, Brazil.
| | | | | | - Luiz Augusto Casulari
- Unit of Endocrinology, Faculty of Medicine and Post-Graduation Program in Health Sciences, University of Brasilia, Brasilia, Brazil
| | | | - Luciana Ansaneli Naves
- Unit of Endocrinology, Faculty of Medicine and Post-Graduation Program in Health Sciences, University of Brasilia, Brasilia, Brazil
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Gomes-Porras M, Cárdenas-Salas J, Álvarez-Escolá C. Somatostatin Analogs in Clinical Practice: a Review. Int J Mol Sci 2020; 21:ijms21051682. [PMID: 32121432 PMCID: PMC7084228 DOI: 10.3390/ijms21051682] [Citation(s) in RCA: 116] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 02/22/2020] [Accepted: 02/25/2020] [Indexed: 12/14/2022] Open
Abstract
Somatostatin analogs are an invaluable therapeutic option in the diagnosis and treatment of somatotropinomas, thyrotropinomas, and functioning and non-functioning gastroenteropancreatic neuroendocrine tumors. They should also be considered an effective and safe therapeutic alternative to corticotropinomas, gonadotropinomas, and prolactinomas resistant to dopamine agonists. Somatostatin analogs have also shown to be useful in the treatment of other endocrine diseases (congenital hyperinsulinism, Graves’ orbitopathy, diabetic retinopathy, diabetic macular edema), non-endocrine tumors (breast, colon, prostate, lung, and hepatocellular), and digestive diseases (chronic refractory diarrhea, hepatorenal polycystosis, gastrointestinal hemorrhage, dumping syndrome, and intestinal fistula).
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Affiliation(s)
- Mariana Gomes-Porras
- Department of Endocrinology, “La Paz” University Hospital. Paseo de la Castellana, 261, 28046 Madrid, Spain;
| | - Jersy Cárdenas-Salas
- Department of Endocrinology, “Fundación Jiménez-Diaz” University Hospital. Av. de los Reyes Católicos, 2, 28040 Madrid, Spain;
| | - Cristina Álvarez-Escolá
- Department of Endocrinology, “La Paz” University Hospital. Paseo de la Castellana, 261, 28046 Madrid, Spain;
- Correspondence: ; Tel.: +34-917-277-209
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16
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Peral C, Cordido F, Gimeno-Ballester V, Mir N, Sánchez-Cenizo L, Rubio-Rodríguez D, Rubio-Terrés C. Cost-effectiveness analysis of second-line pharmacological treatment of acromegaly in Spain. Expert Rev Pharmacoecon Outcomes Res 2019; 20:105-114. [PMID: 31055976 DOI: 10.1080/14737167.2019.1610396] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Objective: To estimate the cost-effectiveness of second-line pharmacological treatments in patients with acromegaly resistant to first-generation somatostatin analogues (FG SSA) from the Spanish National Health System (NHS) perspective.Methods: A Markov model was developed to analyze the cost-effectiveness of pegvisomant and pasireotide in FG SSA-resistant acromegaly, simulating a cohort of patients from the treatment beginning to death. Treatment with pegvisomant or pasireotide was compared to FG SSA retreatment. Efficacy data were obtained from clinical trials and utilities from the literature. Direct health costs were obtained from Spanish sources (€2018).Results: The Incremental Cost Effectiveness Ratio (ICER) of pegvisomant vs. FG SSA was €85,869/Quality-adjusted life years (QALY). The ICER of pasireotide vs. FG SSA was €551,405/QALY. The ICER was mainly driven by the incremental efficacy (4.41 QALY for pegvisomant vs. FG SSA and 0.71 QALY for pasireotide vs. FG SSA), with a slightly lower increase in costs with pegvisomant (€378,597 vs. FG SSA) than with pasireotide (€393,151 vs. FG SSA).Conclusion: The ICER of pasireotide compared to FG SSA was six times higher than the ICER of pegvisomant vs. FG SSA. Pegvisomant is a more cost-effective alternative for the treatment of acromegaly in FG SSA-resistant patients in the Spanish NHS.
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Affiliation(s)
- Carmen Peral
- Health Economics and Outcomes Research Department, Pfizer S.L.U, Alcobendas (Madrid), Spain
| | - Fernando Cordido
- Endocrinology Department, Complejo Hospitalario Universitario A Coruña, and Universidad de A Coruña, A Coruña, Spain
| | | | - Nuria Mir
- Medical Affairs Department, Pfizer S.L.U, Alcobendas (Madrid), Spain
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Abstract
Acromegaly is a rare disease, associated with multiple organs and systems damage. Thanks to implementation of registries, systematic data gathering, knowledge sharing and standardizing medical practices for optimal care greatly improved. Data concerning 19 national acromegaly registries are available, involving more than 16,000 patients. The weighted mean age of diagnosis is 45.2 years and seems stable over time. A macroadenoma is found in 75% of the cases. The proportion of patients operated (>80%) did not change along time. By contrast, use of radiotherapy has decreased while use of medical therapy increased. If judged on IGF-I levels, acromegaly is controlled in 61.3% of the patients. The disease control rate has improved over time. This is likely due to the development of medical treatment strategies. The collection of data about comorbidities in national registries is much less comprehensive than those about epidemiology, disease control or treatment strategies. The most reported comorbidities are arterial hypertension and diabetes. Data concerning mortality trends are controversial. It seems that cancer has become a leading cause of death in acromegaly patients in the last decade, period in which life expectancy improved, while cardiovascular mortality decreased. In conclusion, acromegaly registries offer a global view of the disease with no "a priori" assumptions. This is of outmost importance, because of the large amount of data and the huge number of associated comorbidities. This will help to establish guidelines for management of this rare disease.
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Affiliation(s)
- Luigi Maione
- Assistance Publique-Hôpitaux de Paris (AP-HP), Service d'Endocrinologie et des Maladies de la Reproduction, Centre de Référence des Maladies Rares de l'Hypophyse, Hôpital de Bicêtre, F-94276 Le Kremlin-Bicêtre, France; UMR-S1185 Université Paris-Sud, Univ Paris-Saclay, F-94276 Le Kremlin-Bicêtre, France; Institut National de la Santé et de la Recherche Médicale (Inserm) U1185, F-94276 Le Kremlin Bicêtre, France
| | - Philippe Chanson
- Assistance Publique-Hôpitaux de Paris (AP-HP), Service d'Endocrinologie et des Maladies de la Reproduction, Centre de Référence des Maladies Rares de l'Hypophyse, Hôpital de Bicêtre, F-94276 Le Kremlin-Bicêtre, France; UMR-S1185 Université Paris-Sud, Univ Paris-Saclay, F-94276 Le Kremlin-Bicêtre, France; Institut National de la Santé et de la Recherche Médicale (Inserm) U1185, F-94276 Le Kremlin Bicêtre, France.
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18
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Gadelha MR, Kasuki L, Lim DST, Fleseriu M. Systemic Complications of Acromegaly and the Impact of the Current Treatment Landscape: An Update. Endocr Rev 2019; 40:268-332. [PMID: 30184064 DOI: 10.1210/er.2018-00115] [Citation(s) in RCA: 197] [Impact Index Per Article: 39.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 07/26/2018] [Indexed: 12/19/2022]
Abstract
Acromegaly is a chronic systemic disease with many complications and is associated with increased mortality when not adequately treated. Substantial advances in acromegaly treatment, as well as in the treatment of many of its complications, mainly diabetes mellitus, heart failure, and arterial hypertension, were achieved in the last decades. These developments allowed change in both prevalence and severity of some acromegaly complications and furthermore resulted in a reduction of mortality. Currently, mortality seems to be similar to the general population in adequately treated patients with acromegaly. In this review, we update the knowledge in complications of acromegaly and detail the effects of different acromegaly treatment options on these complications. Incidence of mortality, its correlation with GH (cumulative exposure vs last value), and IGF-I levels and the shift in the main cause of mortality in patients with acromegaly are also addressed.
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Affiliation(s)
- Mônica R Gadelha
- Neuroendocrinology Research Center/Endocrine Section and Medical School, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.,Neuroendocrine Section, Instituto Estadual do Cérebro Paulo Niemeyer, Secretaria Estadual de Saúde do Rio de Janeiro, Rio de Janeiro, Brazil.,Neuropathology and Molecular Genetics Laboratory, Instituto Estadual do Cérebro Paulo Niemeyer, Rio de Janeiro, Brazil
| | - Leandro Kasuki
- Neuroendocrinology Research Center/Endocrine Section and Medical School, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.,Neuroendocrine Section, Instituto Estadual do Cérebro Paulo Niemeyer, Secretaria Estadual de Saúde do Rio de Janeiro, Rio de Janeiro, Brazil.,Endocrine Unit, Hospital Federal de Bonsucesso, Rio de Janeiro, Brazil
| | - Dawn S T Lim
- Department of Endocrinology, Singapore General Hospital, Singapore, Singapore
| | - Maria Fleseriu
- Department of Endocrinology, Diabetes and Metabolism, Oregon Health and Science University, Portland, Oregon.,Department of Neurological Surgery, Oregon Health and Science University, Portland, Oregon.,Northwest Pituitary Center, Oregon Health and Science University, Portland, Oregon
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19
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Fan Y, Jiang S, Hua M, Feng S, Feng M, Wang R. Machine Learning-Based Radiomics Predicts Radiotherapeutic Response in Patients With Acromegaly. Front Endocrinol (Lausanne) 2019; 10:588. [PMID: 31507537 PMCID: PMC6718446 DOI: 10.3389/fendo.2019.00588] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 08/12/2019] [Indexed: 12/29/2022] Open
Abstract
Background: Prediction of radiotherapeutic response before radiotherapy could help determine individual treatment strategies for patients with acromegaly. Objective: To develop and validate a machine-learning-based multiparametric MRI radiomics model to non-invasively predict radiotherapeutic response in patients with acromegaly. Methods: This retrospective study included 57 acromegaly patients who underwent postoperative radiotherapy between January 2008 and January 2016. Manual lesion segmentation and radiomics analysis were performed on each pituitary adenoma, and 1561 radiomics features were extracted from each sequence. A radiomics signature was built with a support vector machine using leave-one-out cross-validation for feature selection. Multivariable logistic regression analysis was used to select appropriate clinicopathological features to construct a clinical model, which was then combined with the radiomics signature to construct a radiomics model. The performance of this radiomic model was assessed using receiver operating characteristics (ROC) analysis and its calibration, discriminating ability, clinical usefulness. Results: At 3-years after radiotherapy, 25 patients had achieved remission and 32 patients had not. The clinical model incorporating seven clinical features had an area under the ROC (AUC) of 0.86 for predicting radiotherapeutic response, and performed better than any single clinical feature. The radiomics signature constructed with six radiomics features had a significantly higher AUC of 0.92. The radiomics model showed good discrimination abilities and calibration, with an AUC of 0.96. Decision curve analysis confirmed the clinical utility of the radiomics model. Conclusion: Using pre-radiotherapy clinical and MRI data, we developed a radiomics model with favorable performance for individualized non-invasive prediction of radiotherapeutic response, which may help in identifying acromegaly patients who are likely to benefit from radiotherapy.
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Affiliation(s)
- Yanghua Fan
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shenzhong Jiang
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Min Hua
- School of Electrical Engineering and Automation, East China Jiaotong University, Nanchang, China
| | - Shanshan Feng
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ming Feng
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- *Correspondence: Renzhi Wang
| | - Renzhi Wang
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Ming Feng ;
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20
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González B, Vargas G, de Los Monteros ALE, Mendoza V, Mercado M. Persistence of Diabetes and Hypertension After Multimodal Treatment of Acromegaly. J Clin Endocrinol Metab 2018; 103:2369-2375. [PMID: 29618021 DOI: 10.1210/jc.2018-00325] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 03/26/2018] [Indexed: 02/02/2023]
Abstract
CONTEXT Diabetes and hypertension are frequent comorbidities of acromegaly. OBJECTIVE To analyze the course of diabetes and hypertension at diagnosis and after multimodal therapy in a large cohort of patients with acromegaly. DESIGN AND SETTING Retrospective study at a tertiary care center. PATIENTS AND METHODS A total of 522 patients with acromegaly treated according to a preestablished protocol. MAIN OUTCOME MEASURES Prevalence of diabetes and hypertension and its relationship with biochemical indices of acromegalic control. RESULTS The cohort was stratified according to disease activity upon last visit to clinic: (1) surgical remission (n = 122), (2) pharmacologically controlled (n = 92), (3) active disease (n = 148), (4) insulinlike growth factor (IGF)-1 discordance (n = 64), and (5) growth hormone (GH) discordance (n = 96). The prevalence of diabetes and hypertension at diagnosis was 30% and 37%, respectively, and did not change upon the last visit (30.6% and 38%). Both comorbidities were more prevalent at diagnosis and on the last visit than in the general population. Diabetes was less prevalent on the last visit in patients who achieved surgical remission than in those who persisted with active disease (25% vs 40%, P = 0.01). Upon multivariate analysis, diabetes was associated with an IGF-1 at diagnosis >2× upper limit of normal, with the persistence of active acromegaly, the presence of hypertension upon the last visit, with the presence of a macroadenoma, and with female sex. CONCLUSION Our findings underscore the importance of an integral approach when managing these patients, focusing not only on the control of GH and IGF-1 levels but also on the timely diagnosis and the specific treatment of each comorbidity.
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Affiliation(s)
- Baldomero González
- Endocrinology Service and the Experimental Endocrinology Unit, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Guadalupe Vargas
- Endocrinology Service and the Experimental Endocrinology Unit, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Ana Laura Espinosa de Los Monteros
- Endocrinology Service and the Experimental Endocrinology Unit, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Victoria Mendoza
- Endocrinology Service and the Experimental Endocrinology Unit, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Moisés Mercado
- Endocrinology Service and the Experimental Endocrinology Unit, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
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21
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Esposito D, Ragnarsson O, Granfeldt D, Marlow T, Johannsson G, Olsson DS. Decreasing mortality and changes in treatment patterns in patients with acromegaly from a nationwide study. Eur J Endocrinol 2018; 178:459-469. [PMID: 29483205 DOI: 10.1530/eje-18-0015] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 02/26/2018] [Indexed: 12/13/2022]
Abstract
CONTEXT New therapeutic strategies have developed for the management of acromegaly over recent decades. Whether this has improved mortality has not been fully elucidated. OBJECTIVE The primary aim was to investigate mortality in a nationwide unselected cohort of patients with acromegaly. Secondary analyses included time trends in mortality and treatment patterns. DESIGN A total of 1089 patients with acromegaly were identified in Swedish National Health Registries between 1987 and 2013. To analyse time trends, the cohort was divided into three periods (1987-1995, 1996-2004 and 2005-2013) based on the year of diagnosis. MAIN OUTCOME MEASURES Using the Swedish population as reference, standardized mortality ratios (SMRs) were calculated with 95% confidence intervals (CIs). RESULTS Overall SMR was 2.79 (95% CI: 2.43-3.15) with 232 observed and 83 expected deaths. Mortality was mainly related to circulatory diseases (SMR: 2.95, 95% CI: 2.35-3.55), including ischemic heart disease (2.00, 1.35-2.66) and cerebrovascular disease (3.99, 2.42-5.55) and malignancy (1.76, 1.27-2.26). Mortality decreased over time, with an SMR of 3.45 (2.87-4.02) and 1.86 (1.04-2.67) during the first and last time period, respectively (P = .015). During the same time periods, the frequency of pituitary surgery increased from 58% to 72% (P < 0.001) and the prevalence of hypopituitarism decreased from 41% to 23% (P < 0.001). CONCLUSIONS Excess mortality was found in this nationwide cohort of patients with acromegaly, mainly related to circulatory and malignant diseases. Although still high, mortality significantly declined over time. This could be explained by the more frequent use of pituitary surgery, decreased prevalence of hypopituitarism and the availability of new medical treatment options.
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Affiliation(s)
- Daniela Esposito
- Department of Endocrinology, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Oskar Ragnarsson
- Department of Endocrinology, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | - Tom Marlow
- Nordic Health Economics, Gothenburg, Sweden
| | - Gudmundur Johannsson
- Department of Endocrinology, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Daniel S Olsson
- Department of Endocrinology, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
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22
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Biagetti B, Obiols G, Martinez Saez E, Cordero E, Mesa J. Pasireotide in acromegaly by aggressive tumors, description of four clinical cases. Towards a personalized medicine. ACTA ACUST UNITED AC 2018; 65:130-132. [PMID: 29371000 DOI: 10.1016/j.endinu.2017.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 12/02/2017] [Accepted: 12/04/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Betina Biagetti
- Servicio de Endocrinología y Nutrición, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, España.
| | - Gabriel Obiols
- Servicio de Endocrinología y Nutrición, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, España
| | - Elena Martinez Saez
- Servicio de Anatomía Patológica, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, España
| | - Esteban Cordero
- Servicio de Neurocirugía, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, España
| | - Jordi Mesa
- Servicio de Endocrinología y Nutrición, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, España
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23
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Salvatori R, Gordon MB, Woodmansee WW, Ioachimescu AG, Carver DW, Mirakhur B, Cox D, Molitch ME. A multicenter, observational study of lanreotide depot/autogel (LAN) in patients with acromegaly in the United States: 2-year experience from the SODA registry. Pituitary 2017; 20:605-618. [PMID: 28741071 DOI: 10.1007/s11102-017-0821-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE This analysis evaluates the 2-year effectiveness and safety of lanreotide depot/autogel (LAN), as well as treatment convenience and acromegaly symptom relief, from the Somatuline® Depot for Acromegaly (SODA) registry, a post-marketing, open-label, observational, multicenter, United States registry study. METHODS Patients with acromegaly treated with LAN were eligible for enrollment. Demographics, LAN dose, extended dosing interval (EDI) (interval of injections ≥42 days), insulin-like growth factor 1 (IGF-1), growth hormone (GH), glycated hemoglobin, adverse events (AEs), injection convenience, and symptom data were collected. RESULTS As of September 29, 2014, 241 patients were enrolled in SODA. IGF-1 levels below age- and gender-adjusted upper normal limit (ULN) were achieved in 71.2% at month (M) 12 and 74.4% at M24; GH ≤2.5 µg/L in 83.3% at M12 and 80.0% at M24; GH <1.0 µg/L in 61.7% at M12 and 61.4% at M24. Both IGF-1 < ULN and GH ≤2.5 µg/L were achieved in 65.0% at M12 and 54.8% at M24; both IGF-1 < ULN and GH < 1.0 µg/L were achieved in 51.7 and 42.9% at M12 and M24, respectively. EDI regimen was 5.0% at baseline and 12.0% at M24. At M24, acromegaly symptoms appeared stable or improved. The most common AE was arthralgia (25.7%). Among 106 serious AEs reported by 42 patients, 10 were deemed related to therapy in 9 patients. At M24, 73.1% of patients rated LAN as convenient. CONCLUSIONS SODA indicates 2-year biochemical control with majority of patients achieving both IGF-1 < ULN and GH ≤2.5 µg/L. LAN was generally well tolerated with no new or unexpected safety signals reported during the observation period. clinicaltrials.gov Clinical Trial Identifier: NCT00686348.
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Affiliation(s)
- Roberto Salvatori
- Division of Endocrinology, Diabetes and Metabolism, and Pituitary Center, Johns Hopkins University, 1830 East Monument Street #333, Baltimore, MD, 21287, USA.
| | - Murray B Gordon
- Allegheny Neuroendocrinology Center, Division of Endocrinology, Allegheny General Hospital, 420 E North Avenue, Suite 205, Pittsburgh, PA, 15212, USA
| | - Whitney W Woodmansee
- Division of Endocrinology, Diabetes and Hypertension, Brigham's and Women's Hospital, 221 Longwood Avenue, Boston, MA, 02115, USA
| | - Adriana G Ioachimescu
- Department of Medicine, Division of Endocrinology, Metabolism and Lipids and Department of Neurosurgery, Emory University School of Medicine, 1365 B Clifton Road, NE, B6209, Atlanta, GA, 30322, USA
| | - Don W Carver
- Ipsen Biopharmaceuticals, Inc. Statistician Consultant, 106 Allen Road, Basking Ridge, NJ, 07920, USA
| | - Beloo Mirakhur
- Medical Affairs, Ipsen Biopharmaceuticals, Inc., 106 Allen Road, Basking Ridge, NJ, 07920, USA
| | - David Cox
- Medical Affairs, Ipsen Biopharmaceuticals, Inc., 106 Allen Road, Basking Ridge, NJ, 07920, USA
| | - Mark E Molitch
- Division of Endocrinology, Metabolism and Molecular Medicine, Northwestern University Feinberg School of Medicine, 645 North Michigan Avenue, Suite 530, Chicago, IL, 60611, USA
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24
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Petrossians P, Daly AF, Natchev E, Maione L, Blijdorp K, Sahnoun-Fathallah M, Auriemma R, Diallo AM, Hulting AL, Ferone D, Hana V, Filipponi S, Sievers C, Nogueira C, Fajardo-Montañana C, Carvalho D, Hana V, Stalla GK, Jaffrain-Réa ML, Delemer B, Colao A, Brue T, Neggers SJCMM, Zacharieva S, Chanson P, Beckers A. Acromegaly at diagnosis in 3173 patients from the Liège Acromegaly Survey (LAS) Database. Endocr Relat Cancer 2017; 24:505-518. [PMID: 28733467 PMCID: PMC5574208 DOI: 10.1530/erc-17-0253] [Citation(s) in RCA: 145] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 07/21/2017] [Indexed: 12/27/2022]
Abstract
Acromegaly is a rare disorder caused by chronic growth hormone (GH) hypersecretion. While diagnostic and therapeutic methods have advanced, little information exists on trends in acromegaly characteristics over time. The Liège Acromegaly Survey (LAS) Database, a relational database, is designed to assess the profile of acromegaly patients at diagnosis and during long-term follow-up at multiple treatment centers. The following results were obtained at diagnosis. The study population consisted of 3173 acromegaly patients from ten countries; 54.5% were female. Males were significantly younger at diagnosis than females (43.5 vs 46.4 years; P < 0.001). The median delay from first symptoms to diagnosis was 2 years longer in females (P = 0.015). Ages at diagnosis and first symptoms increased significantly over time (P < 0.001). Tumors were larger in males than females (P < 0.001); tumor size and invasion were inversely related to patient age (P < 0.001). Random GH at diagnosis correlated with nadir GH levels during OGTT (P < 0.001). GH was inversely related to age in both sexes (P < 0.001). Diabetes mellitus was present in 27.5%, hypertension in 28.8%, sleep apnea syndrome in 25.5% and cardiac hypertrophy in 15.5%. Serious cardiovascular outcomes like stroke, heart failure and myocardial infarction were present in <5% at diagnosis. Erythrocyte levels were increased and correlated with IGF-1 values. Thyroid nodules were frequent (34.0%); 820 patients had colonoscopy at diagnosis and 13% had polyps. Osteoporosis was present at diagnosis in 12.3% and 0.6-4.4% had experienced a fracture. In conclusion, this study of >3100 patients is the largest international acromegaly database and shows clinically relevant trends in the characteristics of acromegaly at diagnosis.
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Affiliation(s)
| | - Adrian F Daly
- Department of EndocrinologyCHU de Liège, University of Liège, Belgium
| | - Emil Natchev
- Clinical Centre of Endocrinology and GerontologyMedical University, Sofia, Bulgaria
| | - Luigi Maione
- APHP Endocrinology and Reproductive DiseasesParis Sud University, Le Kremlin-Bicêtre, France
| | - Karin Blijdorp
- Section of EndocrinologyDepartment of Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Mona Sahnoun-Fathallah
- Department of EndocrinologyCentre de Référence des Maladies Rares d'Origine Hypophysaire, Hôpital de la Timone, Marseille, France
| | - Renata Auriemma
- Dipartimento Di Medicina Clinica e ChirurgiaSezione di Endocrinologia, University "Federico II", Naples, Italy
| | | | - Anna-Lena Hulting
- Department of Molecular Medicine and SurgeryKarolinska University Hospital, Stockholm, Sweden
| | - Diego Ferone
- Department of Internal MedicineUniversity of Genoa, Genova, Italy
| | - Vaclav Hana
- Third Department of Internal Medicine1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Silvia Filipponi
- Department of Biotechnological and Applied Clinical SciencesUniversity of L'Aquila, L'Aquila, Italy and Neuromed, IRCCS, Pozzilli, Italy
| | - Caroline Sievers
- Department of Internal MedicineEndocrinology and Clinical Chemistry, Max Planck Institute of Psychiatry, Munich, Germany
| | - Claudia Nogueira
- Department of Internal MedicineEndocrinology, Diabetes and Metabolism Unit, Centro Hospitalar de Trás-os-Montes e Alto Douro, Portugal
| | | | - Davide Carvalho
- Department of EndocrinologyDiabetes and Metabolism, Centro Hospitalar S. João, Faculty of Medicine, Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal
| | - Vaclav Hana
- Third Department of Internal Medicine1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Günter K Stalla
- Department of Internal MedicineEndocrinology and Clinical Chemistry, Max Planck Institute of Psychiatry, Munich, Germany
| | - Marie-Lise Jaffrain-Réa
- Department of Biotechnological and Applied Clinical SciencesUniversity of L'Aquila, L'Aquila, Italy and Neuromed, IRCCS, Pozzilli, Italy
| | | | - Annamaria Colao
- Dipartimento Di Medicina Clinica e ChirurgiaSezione di Endocrinologia, University "Federico II", Naples, Italy
| | - Thierry Brue
- Department of EndocrinologyCentre de Référence des Maladies Rares d'Origine Hypophysaire, Hôpital de la Timone, Marseille, France
| | - Sebastian J C M M Neggers
- Section of EndocrinologyDepartment of Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Sabina Zacharieva
- Clinical Centre of Endocrinology and GerontologyMedical University, Sofia, Bulgaria
| | - Philippe Chanson
- APHP Endocrinology and Reproductive DiseasesParis Sud University, Le Kremlin-Bicêtre, France
| | - Albert Beckers
- Department of EndocrinologyCHU de Liège, University of Liège, Belgium
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25
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Sesmilo G, Resmini E, Sambo M, Blanco C, Calvo F, Pazos F, Fernández-Catalina P, Martínez de Icaya P, Páramo C, Fajardo C, Marazuela M, Álvarez-Escolá C, Díez JJ, Perea V. Prevalence of acromegaly in patients with symptoms of sleep apnea. PLoS One 2017; 12:e0183539. [PMID: 28898247 PMCID: PMC5595301 DOI: 10.1371/journal.pone.0183539] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 08/07/2017] [Indexed: 11/19/2022] Open
Abstract
Acromegaly is a rare disease with nonspecific symptoms with acral enlargement being almost universally present at diagnosis. The estimated prevalence is 40-125 cases/million but targeted universal screening studies have found a higher prevalence (about 10 fold). The aim of the ACROSAHS study was to investigate the prevalence of acromegaly and acromegaly comorbidities in patients with sleep apnea symptoms and acral enlargement. ACROSAHS was a Spanish prospective non-interventional epidemiological study in 13 Hospital sleep referral units. Facial and acral enlargement symptoms including: ring size and shoe size increase, tongue, lips and jaws enlargement, paresthesia or carpal tunnel syndrome and widening of tooth spaces, as well as other typical acromegaly comorbidities were recorded with a self-administered questionnaire of patients who attended a first visit for sleep apnea symptoms between 09/2013 and 07/2014. Serum insulin-like growth factor type 1 (IGF1) was measured in patients with ≥1 acral symptom to determine the prevalence of acromegaly. Of the 1557 patients enrolled, 1477 with complete data (72% male) were analyzed. 530 patients (36%) reported at least 1 acral enlargement symptom and were tested for IGF-1, 41 were above range, persisted in 7, and among those, 2 cases of acromegaly were diagnosed (prevalence of at least 1.35 cases/1000). Overall, 1019 patients (69%) had ≥2 acromegaly symptoms and should have been screened according to guidelines; moreover 373 patients (25%) had ≥1 symptom of acral enlargement plus ≥3 other acromegaly symptoms. In conclusion, in patients with sleep apnea symptoms and acral enlargement, we found an acromegaly prevalence of at least 1.35 cases per 1000 and a high prevalence of typical acromegaly symptoms. It is important that sleep specialists are aware of acromegaly symptoms to aid with acromegaly diagnosis.
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Affiliation(s)
- Gemma Sesmilo
- Servicio de endocrinología, Hospital Quirón-Dexeus/Clínica del Sueño Estivill, Barcelona, Spain
- * E-mail:
| | - Eugenia Resmini
- IIB- Sant Pau y Servicio de Endocrinología, Departamento de Medicina, Centro de Investigación Biomédica en Enfermedades Raras (CIBER-ER Unidad 747), Hospital Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marcel Sambo
- Servicio de endocrinología, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - Concepción Blanco
- Servicio de endocrinología, Hospital Universitario Príncipe de Asturias, Madrid, Spain
| | - Fernando Calvo
- Servicio de endocrinología, Hospital Clínico Universitario Lozano-Blesa, Zaragoza, Spain
| | - Fernando Pazos
- Servicio de endocrinología, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | | | | | - Concepción Páramo
- Servicio de endocrinología, Complexo Hospitalario Universitario De Vigo, Vigo, Spain
| | - Carmen Fajardo
- Servicio de endocrinología, Hospital Universitario de la Ribera, Alzira, Spain
| | - Mónica Marazuela
- Servicio de endocrinología, Hospital de La Princesa, Madrid, Spain
| | | | - Juan Jose Díez
- Servicio de endocrinología, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Verónica Perea
- Servicio de endocrinología, Hospital Quirón-Dexeus/Clínica del Sueño Estivill, Barcelona, Spain
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Carmichael JD, Broder MS, Cherepanov D, Chang E, Mamelak A, Said Q, Neary MP, Bonert V. Long-term treatment outcomes of acromegaly patients presenting biochemically-uncontrolled at a tertiary pituitary center. BMC Endocr Disord 2017; 17:49. [PMID: 28778166 PMCID: PMC5545017 DOI: 10.1186/s12902-017-0199-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 07/27/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Acromegaly is a rare, slowly progressive disorder resulting from excessive growth hormone (GH) production by a pituitary somatotroph tumor. The objective of this study was to examine acromegaly treatment outcomes during long-term care at a specialized pituitary center in patients presenting with lack of biochemical control. METHODS Data came from an acromegaly registry at the Cedars-Sinai Medical Center Pituitary Center (center). Acromegaly patients included in this study were those who presented biochemically-uncontrolled for care at the center. Biochemical control status, based on serum insulin-like growth factor-1 values, was determined at presentation and at study end. Patient characteristics and acromegaly treatments were reported before and after presentation by presenting treatment status and final biochemical control status. Data on long-term follow-up were recorded from 1985 through June 2013. RESULTS Seventy-four patients presented uncontrolled: 40 untreated (54.1%) and 34 (45.9%) previously-treated. Mean (SD) age at diagnosis was 43.2 (14.7); 32 (43.2%) were female patients. Of 65 patients with tumor size information, 59 (90.8%) had macroadenomas. Prior treatments among the 34 previously-treated patients were pituitary surgery alone (47.1%), surgery and medication (41.2%), and medication alone (11.8%). Of the 40 patients without prior treatment, 82.5% achieved control by study end. Of the 34 with prior treatment, 50% achieved control by study end. CONCLUSIONS This observational study shows that treatment outcomes of biochemically-uncontrolled acromegaly patients improve with directed care, particularly for those that initially present untreated. Patients often require multiple modalities of treatment, many of which are offered with the highest quality at specialized pituitary centers. Despite specialized care, some patients were not able to achieve biochemical control with methods of treatment that were available at the time of their treatment, showing the need for additional treatment options.
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Affiliation(s)
- John D. Carmichael
- Pituitary Center, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048 USA
| | - Michael S. Broder
- Partnership for Health Analytic Research, LLC, 280 S. Beverly Dr., Suite 404, Beverly Hills, CA 90212 USA
| | - Dasha Cherepanov
- Partnership for Health Analytic Research, LLC, 280 S. Beverly Dr., Suite 404, Beverly Hills, CA 90212 USA
| | - Eunice Chang
- Partnership for Health Analytic Research, LLC, 280 S. Beverly Dr., Suite 404, Beverly Hills, CA 90212 USA
| | - Adam Mamelak
- Pituitary Center, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048 USA
| | - Qayyim Said
- Health Economics and Outcomes Research, Novartis Pharmaceuticals Corporation, One Health Plaza, East Hanover, NJ 07936 USA
| | - Maureen P. Neary
- Global Oncology Market Access and Policy, Novartis Pharmaceuticals Corporation, One Health Plaza, East Hanover, NJ 07936 USA
| | - Vivien Bonert
- Pituitary Center, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048 USA
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Maione L, Brue T, Beckers A, Delemer B, Petrossians P, Borson-Chazot F, Chabre O, François P, Bertherat J, Cortet-Rudelli C, Chanson P. Changes in the management and comorbidities of acromegaly over three decades: the French Acromegaly Registry. Eur J Endocrinol 2017; 176:645-655. [PMID: 28246150 DOI: 10.1530/eje-16-1064] [Citation(s) in RCA: 115] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2016] [Revised: 02/14/2017] [Accepted: 02/27/2017] [Indexed: 01/25/2023]
Abstract
CONTEXT Acromegaly is a rare disease associated with chronic multisystem complications. National registries have been created in several countries. DESIGN The French Registry contains data on acromegaly epidemiology, management and comorbidities recorded over more than three decades, retrospectively until 1999 and prospectively from 1999 to 2012. RESULTS Data could be analyzed for 999 of the 1034 patients included in the registry (46% males). Disease control, defined as IGF-I normalization (adjusted for age and sex), was achieved in 75% of patients at the last follow-up visit. Half the patients with uncontrolled disease had IGF-I levels below 1.5 times the upper limit of normal (ULN). The proportion of patients with surgically cured disease did not change markedly over time, whereas the proportion of patients with uncontrolled disease fell and the proportion of patients with medically controlled disease rose. Cardiovascular, metabolic, respiratory and rheumatologic comorbidities and their outcomes were recorded for most patients, and no noteworthy overall deterioration was noted over time. Cancer occurred in 10% of patients, for a standardized incidence ratio of 1.34 (95% CI: 0.94-1.87) in men and 1.24 (0.77-1.73) in women. Forty-one patients died during follow-up, for a standardized mortality ratio of 1.05 (0.70-1.42). Most deaths were due to cancer. CONCLUSIONS The majority of patients with acromegaly now have successful disease control thanks to the multistep management. The incidence of comorbidities following diagnosis of acromegaly is very low. Life expectancy is now close to that of the general population, probably owing to better management of the GH/IGF-I excess and comorbidities.
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Affiliation(s)
- Luigi Maione
- Assistance Publique-Hôpitaux de ParisHôpital de Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, Le Kremlin Bicêtre, France
- Univ Paris-SudFaculté de Médecine Paris-Sud, Unité Mixte de Recherche-S1185, Le Kremlin Bicêtre, France
- Institut National de la Santé et de la Recherche Médicale (INSERM) U1185Le Kremlin Bicêtre, France
| | - Thierry Brue
- Université Aix-Marseille and Assistance Publique-Hôpitaux de MarseillePôle ENDO (Endocrinologie, Diabète, Obésité Nutrition), Hôpital de la Conception, Marseille, France
| | - Albert Beckers
- Département de Médecine InterneService d'Endocrinologie, Centre Hospitalier Universitaire de Liège, Université de Liège, Domaine Universitaire du Sart-Tilman, Liège, Belgium
| | - Brigitte Delemer
- Service d'EndocrinologieDiabète et Nutrition, Hôpital Robert Debré, Centre Hospitalier Universitaire de Reims, Reims, France
| | - Patrick Petrossians
- Département de Médecine InterneService d'Endocrinologie, Centre Hospitalier Universitaire de Liège, Université de Liège, Domaine Universitaire du Sart-Tilman, Liège, Belgium
| | - Françoise Borson-Chazot
- Université Lyon 1Lyon, France
- Hospices Civils de LyonFédération d'Endocrinologie du pôle Est, Lyon, France
- INSERM U1052UMR CNRS 5286, Centre de Recherche en Cancérologie de Lyon, Equipe Tumeurs Endocrines, Lyon, France
| | - Olivier Chabre
- Service d'Endocrinologie-Diabétologie-NutritionPôle Digidune, Centre Hospitalier Universitaire de Grenoble and Université Grenoble Alpes, Grenoble, France
| | - Patrick François
- Service de NeurochirurgieCHRU de Tours; and Université François-Rabelais de Tours, Tours, France
| | - Jérôme Bertherat
- Assistance Publique Hôpitaux de ParisService d'Endocrinologie, Hôpital Cochin, and Université Paris Descartes, Sorbonne Paris Cité, and INSERM U1016, CNRS UM8104, Institut Cochin, Paris, France
| | - Christine Cortet-Rudelli
- Service de DiabétologieEndocrinologie et des Maladies Métaboliques, Hôpital Huriez, CHU de Lille, Lille, France
| | - Philippe Chanson
- Assistance Publique-Hôpitaux de ParisHôpital de Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, Le Kremlin Bicêtre, France
- Univ Paris-SudFaculté de Médecine Paris-Sud, Unité Mixte de Recherche-S1185, Le Kremlin Bicêtre, France
- Institut National de la Santé et de la Recherche Médicale (INSERM) U1185Le Kremlin Bicêtre, France
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Abstract
Purpose Treatment of acromegaly has undergone important progress in the last 20 years mainly due to the development of new medical options and advances in surgical techniques. Pituitary surgery is usually first-line therapy, and medical treatment is indicated for persistent disease, while radiation (RT) is often used as third-line therapy. The benefits of RT (tumor volume control and decreased hormonal secretion) are hampered by the long latency of the effect and the high risk of adverse effects. Stereotactic RT methods have been developed with the aim to provide more precise targeting of the tumor with better control of the radiation dose received by the adjacent brain structures. The purpose of this review is to present the updates in the efficacy and safety of pituitary RT in acromegalic patients, with an emphasis on the new stereotactic radiation techniques. Methods A systematic review was performed using PubMed and articles/abstracts and reviews detailing RT in acromegaly from 2000 to 2016 were included. Results Stereotactic radiosurgery and fractionated stereotactic RT (FSRT) for patients with persistent active acromegaly after surgery and/or during medical therapy provide comparable high rates of tumor control, i.e. stable or decrease in size of the tumor in 93-100% of patients at 5-10 years and endocrinological remission in 40-60% of patients at 5 years. Hypofractionated RT is an optimal option for tumors located near the optic structures, due to its lower toxicity for the optic nerves compared to single-dose radiosurgery. The rate of new hypopituitarism varies from 10 to 50% at 5 years and increases with the duration of follow-up. The risk for other radiation-induced complications is usually low (0-5% for new visual deficits, cranial nerves damage or brain radionecrosis and 0-1% for secondary brain tumors) and risk of stroke may be higher in FSRT. Conclusion Although the use of radiotherapy in patients with acromegaly has decreased with advances in medical treatments, it remains an effective treatment option after unsuccessful surgery and/or resistance or unavailability of medical therapy. Long-term studies evaluating secondary morbidity and mortality rate after the new stereotactic techniques are needed, in order to evaluate their potential brain-sparing effect.
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Affiliation(s)
- Monica Livia Gheorghiu
- C.I. Parhon" National Institute of Endocrinology, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.
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Lesén E, Granfeldt D, Houchard A, Dinet J, Berthon A, Olsson DS, Björholt I, Johannsson G. Comorbidities, treatment patterns and cost-of-illness of acromegaly in Sweden: a register-linkage population-based study. Eur J Endocrinol 2017; 176:203-212. [PMID: 27932528 DOI: 10.1530/eje-16-0623] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 11/03/2016] [Accepted: 11/15/2016] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Acromegaly is a complex endocrine disease with multiple comorbidities. Treatment to obtain biochemical remission includes surgery, medical therapy and radiation. We aimed to describe comorbidities, treatment patterns and cost-of-illness in patients with acromegaly in Sweden. DESIGN A nationwide population-based study. METHODS Patients with acromegaly were identified and followed in national registers in Sweden. Longitudinal treatment patterns were assessed in patients diagnosed between July 2005 and December 2013. The cost-of-illness during 2013 was estimated from a societal perspective among patients diagnosed between 1987 and 2013. RESULTS Among 358 patients with acromegaly (48% men, mean age at diagnosis 50.0 (s.d. 15.3) years) at least one comorbidity was reported in 81% (n = 290). The most common comorbidities were hypertension (40%, n = 142), neoplasms outside the pituitary (30%, n = 109), hypopituitarism (22%, n = 80) and diabetes mellitus (17%, n = 61). Acromegaly treatment was initiated on average 3.7 (s.d. 6.9) months after diagnosis. Among the 301 treated patients, the most common first-line treatments were surgery (60%, n = 180), somatostatin analogues (21%, n = 64) and dopamine agonists (14%, n = 41). After primary surgery, 24% (n = 44) received somatostatin analogues. The annual per-patient cost was €12 000; this was €8700 and €16 000 if diagnosed before or after July 2005, respectively. The cost-of-illness for acromegaly and its comorbidities was 77% from direct costs and 23% from production loss. CONCLUSIONS The prevalence of comorbidity is high in patients with acromegaly. The most common first-line treatment in acromegalic patients was surgery followed by somatostatin analogues. The annual per-patient cost of acromegaly and its comorbidities was €12 000.
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Affiliation(s)
- Eva Lesén
- Nordic Health EconomicsGothenburg, Sweden
| | | | | | | | | | - Daniel S Olsson
- Department of Internal Medicine and Clinical NutritionInstitute of Medicine, Sahlgrenska Academy, University of Gothenburg and Department of Endocrinology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | - Gudmundur Johannsson
- Department of Internal Medicine and Clinical NutritionInstitute of Medicine, Sahlgrenska Academy, University of Gothenburg and Department of Endocrinology, Sahlgrenska University Hospital, Gothenburg, Sweden
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Gheorghiu ML, Fleseriu M. STEREOTACTIC RADIATION THERAPY IN PITUITARY ADENOMAS, IS IT BETTER THAN CONVENTIONAL RADIATION THERAPY? ACTA ENDOCRINOLOGICA-BUCHAREST 2017; 13:476-490. [PMID: 31149219 DOI: 10.4183/aeb.2017.476] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
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 first-line 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, long-term studies evaluating secondary morbidity and mortality are needed.
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Affiliation(s)
- M L Gheorghiu
- "Carol Davila" University of Medicine and Pharmacy, "C.I. Parhon" National Institute of Endocrinology, Bucharest, Romania
| | - M Fleseriu
- Oregon Health & Science University, Departments of Medicine (Endocrinology) and Neurological Surgery, and Northwest Pituitary Center, Portland, USA
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Portocarrero-Ortiz LA, Vergara-Lopez A, Vidrio-Velazquez M, Uribe-Diaz AM, García-Dominguez A, Reza-Albarrán AA, Cuevas-Ramos D, Melgar V, Talavera J, Rivera-Hernandez ADJ, Valencia-Méndez CV, Mercado M. The Mexican Acromegaly Registry: Clinical and Biochemical Characteristics at Diagnosis and Therapeutic Outcomes. J Clin Endocrinol Metab 2016; 101:3997-4004. [PMID: 27428551 DOI: 10.1210/jc.2016-1937] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
CONTEXT Acromegaly is a systemic disorder caused by a GH-secreting pituitary adenoma. As with other rare diseases, acromegaly registries developed in various European countries have provided us with important information. OBJECTIVE The objective of the study was to analyze the epidemiological, clinical, biochemical, and therapeutic data from the Mexican Acromegaly Registry (MAR). SETTING The setting of the study was a nationwide patient registry. DESIGN AND METHODOLOGY The MAR was created in 2009. It gathers data from 24 participating centers belonging to three different institutions using a specifically designed on-line platform. Only patients diagnosed after 1990 were included in the program. RESULTS A total of 2057 patients (51% female, mean age at diagnosis 41.1 ± 24.5 y) have been registered for an estimated prevalence of 18 cases per 1 million inhabitants. Hypertension, glucose intolerance, diabetes, and dyslipidemia were present in 27%, 18.4%, 30%, and 24% of the patients, respectively. The IGF-1 level at diagnosis and the concomitant presence of hypertension were significantly associated with the development of diabetes. Transsphenoidal surgery was the primary treatment in 72% of the patients. Pharmacological treatment, mostly with somatostatin analogs, was administered primarily and adjunctively in 26% and 54% of the patients, respectively. Treatment choice varied among the three participating institutions, with the predominance of pharmacological therapy in two of them and of radiation therapy in the third. Therapeutic outcomes were similar to those reported in the European registries. CONCLUSIONS The MAR is the largest and first non-European registry of the disease. Our findings highlight important within-country differences in treatment choice due to variations in the availability of resources.
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Affiliation(s)
- Lesly A Portocarrero-Ortiz
- Instituto Nacional de Neurología y Neurocirugía (L.A.P.-O., C.V.V.-M.), 14269 Mexico City, Mexico; Centro Medico Nacional 20 de Noviembre Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (A.V.-L.), 03100 Mexico City, Mexico; Hospital Regional 110, Instituto Mexicano del Seguro Social (M.V.-V.), 44716 Guadalajara, Jal, Mexico; Unidad Medica de Alta Especialidad 189 (A.M.U.-D.), 91755 Veracruz, Ver, Mexico; Unidad Medica de Alta Especialidad Manuel Avila Camacho (A.G.-D.), Instituto Mexicano del Seguro Social, 7200 Puebla, Pue, Mexico; Instituto Nacional de Ciencias Medicas y Nutricion (A.-A.R.-A., D.C.-R.), 14080 Mexico City, Mexico; ABC Neurological Center (V.M., J.T., M.M.), 05300 Mexico City, Mexico; Hospital General Zaragoza (A.d.J.R.-H.), Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, 09100 Mexico City, Mexico; and Hospital de Especialidades Centro Medico Nacional S.XXI, Instituto Mexicano del Seguro Social (M.M.), 01120 Mexico City, Mexico
| | - Alma Vergara-Lopez
- Instituto Nacional de Neurología y Neurocirugía (L.A.P.-O., C.V.V.-M.), 14269 Mexico City, Mexico; Centro Medico Nacional 20 de Noviembre Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (A.V.-L.), 03100 Mexico City, Mexico; Hospital Regional 110, Instituto Mexicano del Seguro Social (M.V.-V.), 44716 Guadalajara, Jal, Mexico; Unidad Medica de Alta Especialidad 189 (A.M.U.-D.), 91755 Veracruz, Ver, Mexico; Unidad Medica de Alta Especialidad Manuel Avila Camacho (A.G.-D.), Instituto Mexicano del Seguro Social, 7200 Puebla, Pue, Mexico; Instituto Nacional de Ciencias Medicas y Nutricion (A.-A.R.-A., D.C.-R.), 14080 Mexico City, Mexico; ABC Neurological Center (V.M., J.T., M.M.), 05300 Mexico City, Mexico; Hospital General Zaragoza (A.d.J.R.-H.), Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, 09100 Mexico City, Mexico; and Hospital de Especialidades Centro Medico Nacional S.XXI, Instituto Mexicano del Seguro Social (M.M.), 01120 Mexico City, Mexico
| | - Maricela Vidrio-Velazquez
- Instituto Nacional de Neurología y Neurocirugía (L.A.P.-O., C.V.V.-M.), 14269 Mexico City, Mexico; Centro Medico Nacional 20 de Noviembre Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (A.V.-L.), 03100 Mexico City, Mexico; Hospital Regional 110, Instituto Mexicano del Seguro Social (M.V.-V.), 44716 Guadalajara, Jal, Mexico; Unidad Medica de Alta Especialidad 189 (A.M.U.-D.), 91755 Veracruz, Ver, Mexico; Unidad Medica de Alta Especialidad Manuel Avila Camacho (A.G.-D.), Instituto Mexicano del Seguro Social, 7200 Puebla, Pue, Mexico; Instituto Nacional de Ciencias Medicas y Nutricion (A.-A.R.-A., D.C.-R.), 14080 Mexico City, Mexico; ABC Neurological Center (V.M., J.T., M.M.), 05300 Mexico City, Mexico; Hospital General Zaragoza (A.d.J.R.-H.), Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, 09100 Mexico City, Mexico; and Hospital de Especialidades Centro Medico Nacional S.XXI, Instituto Mexicano del Seguro Social (M.M.), 01120 Mexico City, Mexico
| | - Ana María Uribe-Diaz
- Instituto Nacional de Neurología y Neurocirugía (L.A.P.-O., C.V.V.-M.), 14269 Mexico City, Mexico; Centro Medico Nacional 20 de Noviembre Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (A.V.-L.), 03100 Mexico City, Mexico; Hospital Regional 110, Instituto Mexicano del Seguro Social (M.V.-V.), 44716 Guadalajara, Jal, Mexico; Unidad Medica de Alta Especialidad 189 (A.M.U.-D.), 91755 Veracruz, Ver, Mexico; Unidad Medica de Alta Especialidad Manuel Avila Camacho (A.G.-D.), Instituto Mexicano del Seguro Social, 7200 Puebla, Pue, Mexico; Instituto Nacional de Ciencias Medicas y Nutricion (A.-A.R.-A., D.C.-R.), 14080 Mexico City, Mexico; ABC Neurological Center (V.M., J.T., M.M.), 05300 Mexico City, Mexico; Hospital General Zaragoza (A.d.J.R.-H.), Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, 09100 Mexico City, Mexico; and Hospital de Especialidades Centro Medico Nacional S.XXI, Instituto Mexicano del Seguro Social (M.M.), 01120 Mexico City, Mexico
| | - Avril García-Dominguez
- Instituto Nacional de Neurología y Neurocirugía (L.A.P.-O., C.V.V.-M.), 14269 Mexico City, Mexico; Centro Medico Nacional 20 de Noviembre Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (A.V.-L.), 03100 Mexico City, Mexico; Hospital Regional 110, Instituto Mexicano del Seguro Social (M.V.-V.), 44716 Guadalajara, Jal, Mexico; Unidad Medica de Alta Especialidad 189 (A.M.U.-D.), 91755 Veracruz, Ver, Mexico; Unidad Medica de Alta Especialidad Manuel Avila Camacho (A.G.-D.), Instituto Mexicano del Seguro Social, 7200 Puebla, Pue, Mexico; Instituto Nacional de Ciencias Medicas y Nutricion (A.-A.R.-A., D.C.-R.), 14080 Mexico City, Mexico; ABC Neurological Center (V.M., J.T., M.M.), 05300 Mexico City, Mexico; Hospital General Zaragoza (A.d.J.R.-H.), Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, 09100 Mexico City, Mexico; and Hospital de Especialidades Centro Medico Nacional S.XXI, Instituto Mexicano del Seguro Social (M.M.), 01120 Mexico City, Mexico
| | - Alfredo Adolfo Reza-Albarrán
- Instituto Nacional de Neurología y Neurocirugía (L.A.P.-O., C.V.V.-M.), 14269 Mexico City, Mexico; Centro Medico Nacional 20 de Noviembre Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (A.V.-L.), 03100 Mexico City, Mexico; Hospital Regional 110, Instituto Mexicano del Seguro Social (M.V.-V.), 44716 Guadalajara, Jal, Mexico; Unidad Medica de Alta Especialidad 189 (A.M.U.-D.), 91755 Veracruz, Ver, Mexico; Unidad Medica de Alta Especialidad Manuel Avila Camacho (A.G.-D.), Instituto Mexicano del Seguro Social, 7200 Puebla, Pue, Mexico; Instituto Nacional de Ciencias Medicas y Nutricion (A.-A.R.-A., D.C.-R.), 14080 Mexico City, Mexico; ABC Neurological Center (V.M., J.T., M.M.), 05300 Mexico City, Mexico; Hospital General Zaragoza (A.d.J.R.-H.), Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, 09100 Mexico City, Mexico; and Hospital de Especialidades Centro Medico Nacional S.XXI, Instituto Mexicano del Seguro Social (M.M.), 01120 Mexico City, Mexico
| | - Daniel Cuevas-Ramos
- Instituto Nacional de Neurología y Neurocirugía (L.A.P.-O., C.V.V.-M.), 14269 Mexico City, Mexico; Centro Medico Nacional 20 de Noviembre Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (A.V.-L.), 03100 Mexico City, Mexico; Hospital Regional 110, Instituto Mexicano del Seguro Social (M.V.-V.), 44716 Guadalajara, Jal, Mexico; Unidad Medica de Alta Especialidad 189 (A.M.U.-D.), 91755 Veracruz, Ver, Mexico; Unidad Medica de Alta Especialidad Manuel Avila Camacho (A.G.-D.), Instituto Mexicano del Seguro Social, 7200 Puebla, Pue, Mexico; Instituto Nacional de Ciencias Medicas y Nutricion (A.-A.R.-A., D.C.-R.), 14080 Mexico City, Mexico; ABC Neurological Center (V.M., J.T., M.M.), 05300 Mexico City, Mexico; Hospital General Zaragoza (A.d.J.R.-H.), Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, 09100 Mexico City, Mexico; and Hospital de Especialidades Centro Medico Nacional S.XXI, Instituto Mexicano del Seguro Social (M.M.), 01120 Mexico City, Mexico
| | - Virgilio Melgar
- Instituto Nacional de Neurología y Neurocirugía (L.A.P.-O., C.V.V.-M.), 14269 Mexico City, Mexico; Centro Medico Nacional 20 de Noviembre Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (A.V.-L.), 03100 Mexico City, Mexico; Hospital Regional 110, Instituto Mexicano del Seguro Social (M.V.-V.), 44716 Guadalajara, Jal, Mexico; Unidad Medica de Alta Especialidad 189 (A.M.U.-D.), 91755 Veracruz, Ver, Mexico; Unidad Medica de Alta Especialidad Manuel Avila Camacho (A.G.-D.), Instituto Mexicano del Seguro Social, 7200 Puebla, Pue, Mexico; Instituto Nacional de Ciencias Medicas y Nutricion (A.-A.R.-A., D.C.-R.), 14080 Mexico City, Mexico; ABC Neurological Center (V.M., J.T., M.M.), 05300 Mexico City, Mexico; Hospital General Zaragoza (A.d.J.R.-H.), Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, 09100 Mexico City, Mexico; and Hospital de Especialidades Centro Medico Nacional S.XXI, Instituto Mexicano del Seguro Social (M.M.), 01120 Mexico City, Mexico
| | - Juan Talavera
- Instituto Nacional de Neurología y Neurocirugía (L.A.P.-O., C.V.V.-M.), 14269 Mexico City, Mexico; Centro Medico Nacional 20 de Noviembre Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (A.V.-L.), 03100 Mexico City, Mexico; Hospital Regional 110, Instituto Mexicano del Seguro Social (M.V.-V.), 44716 Guadalajara, Jal, Mexico; Unidad Medica de Alta Especialidad 189 (A.M.U.-D.), 91755 Veracruz, Ver, Mexico; Unidad Medica de Alta Especialidad Manuel Avila Camacho (A.G.-D.), Instituto Mexicano del Seguro Social, 7200 Puebla, Pue, Mexico; Instituto Nacional de Ciencias Medicas y Nutricion (A.-A.R.-A., D.C.-R.), 14080 Mexico City, Mexico; ABC Neurological Center (V.M., J.T., M.M.), 05300 Mexico City, Mexico; Hospital General Zaragoza (A.d.J.R.-H.), Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, 09100 Mexico City, Mexico; and Hospital de Especialidades Centro Medico Nacional S.XXI, Instituto Mexicano del Seguro Social (M.M.), 01120 Mexico City, Mexico
| | - Aleida de Jesus Rivera-Hernandez
- Instituto Nacional de Neurología y Neurocirugía (L.A.P.-O., C.V.V.-M.), 14269 Mexico City, Mexico; Centro Medico Nacional 20 de Noviembre Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (A.V.-L.), 03100 Mexico City, Mexico; Hospital Regional 110, Instituto Mexicano del Seguro Social (M.V.-V.), 44716 Guadalajara, Jal, Mexico; Unidad Medica de Alta Especialidad 189 (A.M.U.-D.), 91755 Veracruz, Ver, Mexico; Unidad Medica de Alta Especialidad Manuel Avila Camacho (A.G.-D.), Instituto Mexicano del Seguro Social, 7200 Puebla, Pue, Mexico; Instituto Nacional de Ciencias Medicas y Nutricion (A.-A.R.-A., D.C.-R.), 14080 Mexico City, Mexico; ABC Neurological Center (V.M., J.T., M.M.), 05300 Mexico City, Mexico; Hospital General Zaragoza (A.d.J.R.-H.), Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, 09100 Mexico City, Mexico; and Hospital de Especialidades Centro Medico Nacional S.XXI, Instituto Mexicano del Seguro Social (M.M.), 01120 Mexico City, Mexico
| | - Carla Valentina Valencia-Méndez
- Instituto Nacional de Neurología y Neurocirugía (L.A.P.-O., C.V.V.-M.), 14269 Mexico City, Mexico; Centro Medico Nacional 20 de Noviembre Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (A.V.-L.), 03100 Mexico City, Mexico; Hospital Regional 110, Instituto Mexicano del Seguro Social (M.V.-V.), 44716 Guadalajara, Jal, Mexico; Unidad Medica de Alta Especialidad 189 (A.M.U.-D.), 91755 Veracruz, Ver, Mexico; Unidad Medica de Alta Especialidad Manuel Avila Camacho (A.G.-D.), Instituto Mexicano del Seguro Social, 7200 Puebla, Pue, Mexico; Instituto Nacional de Ciencias Medicas y Nutricion (A.-A.R.-A., D.C.-R.), 14080 Mexico City, Mexico; ABC Neurological Center (V.M., J.T., M.M.), 05300 Mexico City, Mexico; Hospital General Zaragoza (A.d.J.R.-H.), Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, 09100 Mexico City, Mexico; and Hospital de Especialidades Centro Medico Nacional S.XXI, Instituto Mexicano del Seguro Social (M.M.), 01120 Mexico City, Mexico
| | - Moisés Mercado
- Instituto Nacional de Neurología y Neurocirugía (L.A.P.-O., C.V.V.-M.), 14269 Mexico City, Mexico; Centro Medico Nacional 20 de Noviembre Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (A.V.-L.), 03100 Mexico City, Mexico; Hospital Regional 110, Instituto Mexicano del Seguro Social (M.V.-V.), 44716 Guadalajara, Jal, Mexico; Unidad Medica de Alta Especialidad 189 (A.M.U.-D.), 91755 Veracruz, Ver, Mexico; Unidad Medica de Alta Especialidad Manuel Avila Camacho (A.G.-D.), Instituto Mexicano del Seguro Social, 7200 Puebla, Pue, Mexico; Instituto Nacional de Ciencias Medicas y Nutricion (A.-A.R.-A., D.C.-R.), 14080 Mexico City, Mexico; ABC Neurological Center (V.M., J.T., M.M.), 05300 Mexico City, Mexico; Hospital General Zaragoza (A.d.J.R.-H.), Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, 09100 Mexico City, Mexico; and Hospital de Especialidades Centro Medico Nacional S.XXI, Instituto Mexicano del Seguro Social (M.M.), 01120 Mexico City, Mexico
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The risks of overlooking the diagnosis of secreting pituitary adenomas. Orphanet J Rare Dis 2016; 11:135. [PMID: 27716353 PMCID: PMC5052978 DOI: 10.1186/s13023-016-0516-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 09/16/2016] [Indexed: 01/06/2023] Open
Abstract
Secreting pituitary adenomas that cause acromegaly and Cushing’s disease, as well as prolactinomas and thyrotroph adenomas, are uncommon, usually benign, slow-growing tumours. The rarity of these conditions means that their diagnosis is not familiar to most non-specialist physicians. Consequently, pituitary adenomas may be overlooked and remain untreated, and affected individuals may develop serious comorbidities that reduce their quality of life and life expectancy. Because many signs and symptoms of pituitary adenomas overlap with those of other, more common disorders, general practitioners and non-endocrinology specialists need to be aware of the “red flags” suggestive of these conditions. A long duration of active disease in patients with secreting pituitary adenomas is associated with an increased risk of comorbidities and reduced quality of life. Appropriate treatment can lead to disease remission, and, although some symptoms may persist in some patients, treatment usually reduces the incidence and severity of comorbidities and improves quality of life. Therefore, correct, early diagnosis and characterization of a pituitary adenoma is crucial for patients, to trigger timely, appropriate treatment and to optimize outcome. This article provides an overview of the epidemiology of hormonal syndromes associated with pituitary adenomas, discusses the difficulties of and considerations for their diagnosis, and reviews the comorbidities that may develop, but can be prevented, by accurate diagnosis and appropriate treatment. We hope this review will help general practitioners and non-endocrinology specialists to suspect secreting pituitary adenomas and refer patients to an endocrinologist for confirmation of the diagnosis and treatment.
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Losa M, Bollerslev J. Pros and cons in endocrine practice: pre-surgical treatment with somatostatin analogues in acromegaly. Endocrine 2016; 52:451-7. [PMID: 26785848 DOI: 10.1007/s12020-015-0853-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 12/30/2015] [Indexed: 12/16/2022]
Abstract
The aim of this commentary is to balance the pros and cons for pre-surgical SSA treatment in a modern perspective ending up with a pragmatic recommendation for treatment based on the current evidence and expertise of the authors. Even though prospective and randomized studies in this particular area are hampered by obvious limitations, the interpretation of the four published trials has in general been in favor of pre-treatment with SSA, showing a better outcome following surgery. However, major drawbacks of these studies, such as non-optimal diagnostic criteria for cure, potential selection bias, and timing of the postoperative evaluation in SSA pre-treated patients, limit their overall interpretation. Three matched-controlled studies showed remarkably similar results with no apparent beneficial effect of SSA pre-treatment on surgical outcome. Both prospective, randomized studies and retrospective studies did not find any significant difference in the rate of endocrine and non-endocrine complications related to surgery, despite the beneficial clinical effects of SSA treatment in most acromegalic patients. The newly diagnosed patient with acromegaly should be carefully evaluated in the trans-disciplinary neuroendocrine team and treatment individualized accordingly. The issue of SSA pre-treatment to improve surgical outcome is yet to be settled and further methodologically sound studies are probably necessary to clarify this point.
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Affiliation(s)
- Marco Losa
- Pituitary Unit, Department of Neurosurgery, Istituto Scientifico San Raffaele, Università Vita-Salute, Via Olgettina 60, 20132, Milan, Italy.
| | - Jens Bollerslev
- Section of Specialized Endocrinology, Medical Clinic B, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, University in Oslo, Oslo, Norway
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López Gavilanez E, Guerrero Franco K, Solórzano Zambrano N, Navarro Chávez M, López Estrella C, Vaca Burbano L, Marriott Díaz E. Epidemiology of acromegaly in Ecuador. ENDOCRINOLOGIA Y NUTRICION : ORGANO DE LA SOCIEDAD ESPANOLA DE ENDOCRINOLOGIA Y NUTRICION 2016; 63:333-8. [PMID: 27158065 DOI: 10.1016/j.endonu.2016.03.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Revised: 03/10/2016] [Accepted: 03/10/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To assess the epidemiology of acromegaly in the city of Guayaquil, Ecuador, and to compare our results to those reported in the literature. PATIENTS, MATERIAL AND METHODS An analysis was made of retrospective and prospective data from all patients with acromegaly attending endocrinology clinics at the 4 main hospitals of the public health network of Guayaquil from January 2000 to December 2014. Age at diagnosis, estimated delay in diagnosis, imaging studies of pituitary gland, basal growth hormone (GH) level, GH after an oral glucose tolerance test (OGTT-GH), and serum levels of insulin-like growth factor 1 (IGF-1) were recorded. Incidence and prevalence of the disease were estimated using information from the 2010 census of population and housing. RESULTS Forty-eight cases were recorded in the study period in 17 males (35.4%) and 31 females (64.5%); M/F ratio=1.8:1. Mean age at diagnosis was 47.3±16.8 years (range 18-86). Delay in diagnosis was 7.3±6.3 years (range 1-30). Mean age at diagnosis was 47.9±18.2 years in males and 46.3±15.8 years in females. Delay in diagnosis was 10.2±7.9 and 5.7±3.9 years in males and females, respectively. Prevalence of acromegaly is 18.7 cases per million inhabitants, and incidence of acromegaly 1.3 cases per million people per year. CONCLUSIONS Acromegaly predominates in females, and is diagnosed in the fourth decade with a delay of approximately 8 years, usually even longer in males. Incidence and prevalence are lower than reported in international series. The disease is underdiagnosed and underreported in Ecuador.
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Affiliation(s)
| | | | | | | | | | - Luis Vaca Burbano
- Servicio de Neurocirugía, Hospital Docente Policía Nacional N.° 2, Guayaquil, Ecuador
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Broder MS, Chang E, Ludlam WH, Neary MP, Carmichael JD. Patterns of pharmacologic treatment in US patients with acromegaly. Curr Med Res Opin 2016; 32:799-805. [PMID: 26609770 DOI: 10.1185/03007995.2015.1125870] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To establish a baseline pattern of care across academic and community settings, it is important to examine the contemporary treatment of acromegaly. We characterized medical treatment patterns for acromegaly in the US to develop a basis for tracking concordance with guidelines. RESEARCH DESIGN AND METHODS Acromegaly patients were identified in two commercial claims databases for this retrospective analysis. Study subjects had ≥2 medical claims with acromegaly (ICD-9-CM code 253.0) and ≥1 claim for pharmacotherapy (bromocriptine, cabergoline, octreotide SA, octreotide LAR, lanreotide, or pegvisomant) in the study timeframe (1 January 2002-31 December 2013). Patients were considered newly treated if they were continuously enrolled for ≥6 months before first observed treatment and had no claim for pharmacologic treatment during that time. Outcomes included various pharmacotherapies, including combination treatments, and differences between lines of therapy. RESULTS A total of 3150 patients had ≥1 pharmacotherapy (mean age: 46.5 years; 50.1% were female); 1471 were newly treated. Somatostatin receptor ligands (SRLs) were the most common drug class used first line (57.2%); cabergoline (27.8%) was the most common treatment, followed by octreotide LAR (22.3%) and lanreotide (19.7%). SRLs were also the most commonly used second-line (42.8%) and third-line pharmacotherapies (43.9%), with combination therapy (23.2%) and octreotide LAR (19.8%) as the most commonly used treatments, respectively. CONCLUSIONS This study, representing the largest claims-based analysis of acromegaly to date, used two databases across a 12 year period to examine complex treatment patterns in a difficult-to-study disease. Although wide variation in acromegaly treatment patterns exists in US clinical practice, in first-line, second-line, and third-line therapy, SRL was the most commonly used drug class. Drug combinations also varied considerably across lines of therapy. The switching between different monotherapies and varied use of drugs in combination may suggest an unmet need for alternative treatment options. Our claims-based technique of examining treatment patterns may be used for other rare diseases, although high censoring rates may be a challenge.
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Affiliation(s)
- Michael S Broder
- a a Partnership for Health Analytic Research LLC , Beverly Hills , CA , USA
| | - Eunice Chang
- a a Partnership for Health Analytic Research LLC , Beverly Hills , CA , USA
| | - William H Ludlam
- b b Novartis Pharmaceuticals Corporation , East Hanover , NJ , USA
| | - Maureen P Neary
- b b Novartis Pharmaceuticals Corporation , East Hanover , NJ , USA
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Chang JS, Tseng HM, Chang TC. Serial follow-up of presurgical treatment using pasireotide long-acting release with or without octreotide long-acting release for naïve active acromegaly. J Formos Med Assoc 2016; 115:475-80. [PMID: 27117887 DOI: 10.1016/j.jfma.2016.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Revised: 02/04/2016] [Accepted: 02/17/2016] [Indexed: 10/21/2022] Open
Abstract
The aim of the present study was to evaluate the serial changes of GH and IGF-1 in seven patients with naïve, active acromegaly following presurgical treatment of the somatostatin analog pasireotide long-acting release (LAR) and octreotide LAR. The patients were treated with pasireotide LAR with or without octreotide LAR for two years and underwent transsphenoidal adenomectomy. After treatment with the somatostatin analogs, the surgical cure rate was similar to that in patients who underwent transsphenoidal surgery alone. Diabetes insipidus was not identified in any patients after the operation. Pasireotide LAR was effective on GH as well as IGF-1 suppression and tumor size decreasing when used as the primary therapy. Future large-population studies to investigate the surgical curative rate after presurgical treatment with somatostatin analogs in patients with acromegaly and macroadenomas close to the cavernous sinus are warranted. However, that hyperglycemia developed following pre-surgical treatment with pasireotide should take into consideration.
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Affiliation(s)
- Jan-Shun Chang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Ham-Min Tseng
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Tien-Chun Chang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
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Hannon MJ, Barkan AL, Drake WM. The Role of Radiotherapy in Acromegaly. Neuroendocrinology 2016; 103:42-9. [PMID: 26088716 DOI: 10.1159/000435776] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 06/04/2015] [Indexed: 11/19/2022]
Abstract
Radiotherapy has, historically, played a central role in the management of acromegaly, and the last 30 years have seen substantial improvements in the technology used in the delivery of radiation therapy. More recently, the introduction of highly targeted radiotherapy, or 'radiosurgery', has further increased the therapeutic options available in the management of secretory pituitary tumors. Despite these developments, improvements in primary surgical outcomes, an increase in the range and effectiveness of medical therapy options, and long-term safety concerns have combined to dictate that, although still deployed in selected cases, the use of radiotherapy in the management of acromegaly has declined steadily over the past 2 decades. In this article, we review some of the main studies that have documented the efficacy of pituitary radiotherapy on growth hormone hypersecretion and summarize the data around its potential deleterious effects, including hypopituitarism, cranial nerve damage, and the development of radiation-related intracerebral tumors. We also give practical recommendations to guide its future use in patients with acromegaly, generally, as a third-line intervention after neurosurgical intervention in combination with various medical therapy options.
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Affiliation(s)
- Mark J Hannon
- Department of Endocrinology, St. Bartholomew's Hospital, London, UK
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Margusino-Framiñán L, Pertega-Diaz S, Pena-Bello L, Sangiao-Alvarellos S, Outeiriño-Blanco E, Pita-Gutierrez F, Pita-Fernandez S, Cordido F. Cost-effectiveness analysis of preoperative treatment of acromegaly with somatostatin analogue on surgical outcome. Eur J Intern Med 2015; 26:736-41. [PMID: 26300269 DOI: 10.1016/j.ejim.2015.07.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2014] [Revised: 04/19/2015] [Accepted: 07/29/2015] [Indexed: 01/28/2023]
Abstract
CONTEXT There is no uniform standard of care for acromegaly. Due to the high costs involved, steps must be taken to ensure the cost-effective delivery of treatment. OBJECTIVE Taking the results of an earlier meta-analysis as a starting point, this study aims to determine whether treatment with long-acting somatostatin analogue (SSA) prior to surgery improves the cost-effectiveness of the treatment of acromegaly. METHODS The results are presented as an Incremental Cost Effectiveness Ratio (ICER) immediately after surgery, for the following year and over the next four decades. The cure rates percentage (95% CI) for the three randomized prospective controlled trials were 44.4% (34.2-54.7) and 18.2% (10.1-26.3) for preoperative treated and untreated patients respectively. The cost of pharmacological treatments was based on the number of units prescribed, dose and length of treatment. RESULTS The mean (95% CI) ICER immediately after surgery was €17,548 (12,007-33,250). In terms of the postoperative SSA treatment, the ICER changes from positive to negative before two years after surgery. One decade after surgery the ICER per patient/year was €-9973 (-18,798; -6752) for postoperative SSA treatment and €-31,733 (-59,812; -21,483) in the case of postoperative pegvisomant treatment. CONCLUSIONS In centres without optimal surgical results, preoperative treatment of GH-secreting pituitary macroadenomas with SSA not only shows a significant improvement in the surgical results, but is also highly cost-effective, with an ICER per patient/year one decade after surgery, of between €-9973 (-18,798; -6752) and €-31,733 (-59,812; -21,483) for SSA and pegvisomant respectively.
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Affiliation(s)
| | - Sonia Pertega-Diaz
- Clinical Epidemiology and Biostatistics Unit, University Hospital A Coruña, A Coruña, Spain
| | - Lara Pena-Bello
- Instituto de Investigación Biomedica (INIBIC), University Hospital A Coruña, A Coruña, Spain
| | - Susana Sangiao-Alvarellos
- Instituto de Investigación Biomedica (INIBIC), University Hospital A Coruña, A Coruña, Spain; Department of Medicine, Faculty of Health Sciences, University of A Coruña, A Coruña, Spain
| | | | | | | | - Fernando Cordido
- Instituto de Investigación Biomedica (INIBIC), University Hospital A Coruña, A Coruña, Spain; Department of Medicine, Faculty of Health Sciences, University of A Coruña, A Coruña, Spain; Department of Endocrinology, University Hospital A Coruña, A Coruña, Spain.
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Espinosa-de-los-Monteros AL, Gonzalez B, Vargas G, Sosa E, Mercado M. Octreotide LAR treatment of acromegaly in "real life": long-term outcome at a tertiary care center. Pituitary 2015; 18:290-6. [PMID: 24781039 DOI: 10.1007/s11102-014-0570-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To report our day-to day experience with the long-term use of octreotide LAR in the treatment of acromegaly. PATIENTS AND METHODS Patients with acromegaly managed between 2003 and 2012 with octreotide LAR for a median of 27 months (interquartile ranges 12-60) and who had not received radiation therapy or concomitant treatment with cabergoline were retrospectively evaluated. Both primarily treated patients (n = 33) and patients who received octreotide after failed pituitary surgery (adjunctive treatment, n = 124) were included. Full biochemical response was defined as the achievement of a GH <2.5 ng/mL and an IGF-1 <1.2 times the upper limit of normal (× ULN); we also evaluated efficacy using a GH cut off of <1 ng/mL. RESULTS Over 60% of the patients achieved a GH of <2.5 ng/mL. The combined GH (<2.5 ng/mL) and IGF-1 (<1.2 × ULN) target was achieved by 35.5 and 33.6% of the patients treated primarily and adjunctively, respectively; these figures dropped to 22.6 and 23% when using a GH target of <1 ng/mL. All patients reported a significant improvement in acromegalic symptoms. Lower pretreatment GH and IGF-1 levels were both associated with a higher probability of achieving the composite biochemical target. CONCLUSION Currently recommended GH and IGF-1 targets are reached by <36% of patients treated with octreotide LAR in a day-to day practice context. Nevertheless, in most instances a clinical benefit and an improvement in biochemical markers can be clearly documented.
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Affiliation(s)
- Ana Laura Espinosa-de-los-Monteros
- Endocrinology Service, Experimental Endocrinology Unit, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Aritsóteles 68, Polanco, 11560, Mexico City, Mexico
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Sesmilo G, Resmini E, Bernabeu I, Aller J, Soto A, Mora M, Picó A, Fajardo C, Torres E, Alvarez-Escolá C, García R, Blanco C, Cámara R, Gaztambide S, Salinas I, Pozo CD, Castells I, Villabona C, Biagetti B, Webb SM. Escape and lipodystrophy in acromegaly during pegvisomant therapy, a retrospective multicentre Spanish study. Clin Endocrinol (Oxf) 2014; 81:883-90. [PMID: 24612232 DOI: 10.1111/cen.12440] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Revised: 12/02/2013] [Accepted: 02/19/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Pegvisomant is an effective treatment for acromegaly. OBJECTIVE To investigate escape (loss of biochemical control in patients previously controlled) and lipodystrophy in acromegalic patients treated with pegvisomant and to evaluate possible associations with clinical features. PATIENTS AND METHODS Multicentre retrospective study involving 19 Spanish centres. RESULTS Ninety-seven patients were included (59% women, mean age at diagnosis 42 ± 13 years, 80% macroadenomas); mean follow-up on pegvisomant was 5 ± 2·5 years, and 89 (92%) achieved normal IGF-1. Escape was reported in 30/89 (34%) of responders, after a mean treatment duration of 25 ± 21 months. The mean initial dose of pegvisomant was 11 ± 5 mg/day, and mean dose at escape was 14 ± 7 mg/day. Most patients (26/30, 87%) achieved control with dose increase (57%), additional medical treatment (3%) or both (27%). Mean new dose that controlled IGF-1 after escape was 20 ± 7 mg/day. Treatments associated were somatostatin analogues (SSA in 47%), cabergoline (CAB in 47%) and both (6%). Lipodystrophy was observed in 15 patients (13 females), mild in six, moderate in six, severe in three and persistent in four. Among patients with lipodystrophy, three escaped and three were nonresponders to pegvisomant. Four patients discontinued the drug, and four had dose reductions because of lipodystrophy. It tended to be more frequent in females (P = 0·06) and in patients treated with triple association SSA+CAB+PEG (P = 0·018). No relationship between escape and clinical variables was found, except prior CAB (P = 0·04) and metformin treatment (0·02) and grade of lipodystrophy (P = 0·02). CONCLUSIONS A significant proportion of patients treated with pegvisomant escaped (34%); however, the majority (87%) was easily controlled with either dose increase, further medical treatment or both. Lipodystrophy developed in 15%, mostly females, and influenced the response to treatment.
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Affiliation(s)
- Gemma Sesmilo
- Servicio Endocrinología, Hospital Quirón- Dexeus, Barcelona, Spain
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Carmichael JD, Bonert VS, Nuño M, Ly D, Melmed S. Acromegaly clinical trial methodology impact on reported biochemical efficacy rates of somatostatin receptor ligand treatments: a meta-analysis. J Clin Endocrinol Metab 2014; 99:1825-33. [PMID: 24606084 PMCID: PMC4010703 DOI: 10.1210/jc.2013-3757] [Citation(s) in RCA: 112] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Biochemical efficacy of somatostatin receptor ligand (SRL) treatment in acromegaly is defined by metrics for GH and IGF-1 control. Since the earliest therapeutic trials, biochemical control criteria, medical formulations, and assay techniques have evolved. MATERIALS AND METHODS We searched PubMed for English-language trials published from 1974 to 2012 evaluating 10 or more patients, with a duration of more than 3 months and biochemical control as a key objective. We used a random-effects model to compare biochemical outcomes for octreotide and lanreotide trials according to study design characteristics. RESULTS A total of 4464 patients were enrolled in the analyzed trials; 4125 were treated, and 3787 completed study treatment. Overall achieved control rates were 56% for mean GH and 55% for IGF-1 normalization. Treatment duration was significantly related to both GH (P < .001) and IGF-1 control (P = .02). Prior SRL therapy (P = .01), and year of study publication (P = .03) were related to biochemical control for GH but not IGF-1. No statistically significant differences in GH or IGF-1 response rates were observed for multicenter vs single center, retrospective vs prospective, study drug, and preselection for SRL responsiveness. Dosing scheme, GH response criterion, or switch study design were also not statistically significant in determining GH or IGF-1 response rate. CONCLUSIONS Clinical design characteristics anticipated to impart efficacy bias including switching, preselection for SRL responsiveness, and retrospective design had no statistically significant impact on efficacy determination. Later year of publication, study duration, and prior SRL use are significant efficacy determinants for acromegaly trial outcomes.
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Affiliation(s)
- John D Carmichael
- Pituitary Center (J.D.C., V.S.B., S.M.), Department of Medicine, and Department of Neurosurgery (M.N., D.L.), Cedars-Sinai Medical Center, Los Angeles, California 90048
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Giustina A, Chanson P, Kleinberg D, Bronstein MD, Clemmons DR, Klibanski A, van der Lely AJ, Strasburger CJ, Lamberts SW, Ho KKY, Casanueva FF, Melmed S. Expert consensus document: A consensus on the medical treatment of acromegaly. Nat Rev Endocrinol 2014; 10:243-8. [PMID: 24566817 DOI: 10.1038/nrendo.2014.21] [Citation(s) in RCA: 256] [Impact Index Per Article: 25.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
In March 2013, the Acromegaly Consensus Group met to revise and update guidelines for the medical treatment of acromegaly. The meeting comprised experts skilled in the medical management of acromegaly. The group considered treatment goals covering biochemical, clinical and tumour volume outcomes, and the place in guidelines of somatostatin receptor ligands, growth hormone receptor antagonists and dopamine agonists, and alternative modalities for treatment including combination therapy and novel treatments. This document represents the conclusions of the workshop consensus.
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Affiliation(s)
- Andrea Giustina
- Chair of Endocrinology, University of Brescia, via Biseo 17, 25100 Brescia, Italy
| | - Philippe Chanson
- Assistance Publique-Hôpitaux de Paris, Service d'Endocrinologie et des Maladies de la Reproduction, Hôpitaux Universitaires Paris-Sud, Le Kremlin-Bicêtre, Paris, F 94275, France
| | - David Kleinberg
- Neuroendocrine Unit, New York University School of Medicine, Department of Veterans Affairs Medical Centre, 423 East 23rd Street, Room 16043W, New York, NY 10010, USA
| | - Marcello D Bronstein
- Neuroendocrine Unit, Division of Endocrinology and Metabolism, University of São Paulo Medical School, Avenue Dr. Eneas de Carvalho, 255, 7° Andar, Sala 7037, São Paulo, CEP 05403 000, Brazil
| | - David R Clemmons
- Department of Medicine, University of North Carolina, CB# 7170, 8024 Burnett-Womack, Chapel Hill, NC 27599, USA
| | - Anne Klibanski
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA
| | - Aart J van der Lely
- Department of Internal Medicine, Division of Endocrinology, Erasmus Medical Centre, P.O. Box 2040, 3000 CA Rotterdam, Netherlands
| | | | - Steven W Lamberts
- Department of Internal Medicine, Division of Endocrinology, Erasmus Medical Centre, P.O. Box 2040, 3000 CA Rotterdam, Netherlands
| | - Ken K Y Ho
- Princess Alexandra Hospital, 199 Ipswich Road, Brisbane, QLD 4102, Australia
| | - Felipe F Casanueva
- Santiago de Compostela University and CIBERobn, Santiago de Compostela, E-15780, Spain
| | - Shlomo Melmed
- Department of Medicine, Cedars-Sinai Medical Center, Room 2015, 8700 Beverly Boulevard, Los Angeles, CA 90048, USA
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Abstract
INTRODUCTION Acromegaly is a rare disease that severely impacts patients' health all the while, being a slowly progressing illness. In the past decades, advancements in treatment modalities, especially development of new drugs, as well as focused guidelines has improved management of acromegaly. Still, many patients are considered not sufficiently treated and there remains an ongoing need for further development. AREAS COVERED This article reviews new medical treatments currently under clinical investigation (such as pasireotide, oral octreotide and somatoprim) and under experimental development (such as octreotide implants, CAM2029 and ATL-1103). EXPERT OPINION As it seems unlikely that one single agent may achieve cure in 100% of cases, there is an urgent need for new agents that help patients where current medication fails. Imperatively, this means we have to improve our understanding of the underlying pathogenetic and molecular mechanisms.
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Affiliation(s)
- Sylvère Störmann
- Klinikum der Universität München, Medizinische Klinik und Poliklinik IV , Ziemssenstr. 1, 80336 München , Germany +49 0 89 5160 2111 ; +49 0 89 5160 2194 ;
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Alteraciones del metabolismo hidrocarbonado en la acromegalia. Med Clin (Barc) 2013; 141:442-6. [DOI: 10.1016/j.medcli.2013.05.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2013] [Revised: 05/21/2013] [Accepted: 05/23/2013] [Indexed: 11/19/2022]
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Howlett TA, Willis D, Walker G, Wass JAH, Trainer PJ. Control of growth hormone and IGF1 in patients with acromegaly in the UK: responses to medical treatment with somatostatin analogues and dopamine agonists. Clin Endocrinol (Oxf) 2013; 79:689-99. [PMID: 23574573 DOI: 10.1111/cen.12207] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Revised: 01/04/2013] [Accepted: 03/14/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVE We investigated the control of GH and IGF1 in acromegaly in routine clinical practice in the UK on and off medical treatment. DESIGN The UK Acromegaly Register collected routine biochemical and clinical data on patients with acromegaly from 31 UK centres with GH data covering >30y. PATIENTS We identified 2572 patients. Somatostatin analogues (SMS) were used in 40·6% and dopamine agonists (DA) in 41·4%. MEASUREMENTS We identified 29,181 GH records linked to data on IGF1, surgery, radiotherapy and medical treatment and derived data on 9900 distinct Periods of Care including 4206 courses of medical treatment. We considered GH controlled when ≤2 μg/l. RESULTS Control of GH and IGF1 improved over time, particularly on medical treatment. Control on medical treatment was better after prior surgery and/or radiotherapy. On long-term SMS, GH was controlled in 75%, IGF1 in 69% and both in 55%; on long-term DA, GH control was similar but IGF1 worse (77%/55%/45%). Responses to long-term treatment with octreotide LAR and lanreotide autogel were broadly similar, but we noted a failure to escalate SMS to maximal effective dose. Increasing precourse GH levels were associated with a decreasing proportion who achieved control, despite greater suppression from baseline. CONCLUSIONS Control of acromegaly in the UK is improving, but 'safe' GH levels are still only achieved in 75% on long-term medical treatment, with GH and IGF1 both normalized in no more than 55% on SMS and 36% on cabergoline. It remains unclear whether the control of GH, but not IGF1, observed in many patients is sufficient to restore long-term morbidity and mortality to normal.
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The Liege Acromegaly Survey (LAS): a new software tool for the study of acromegaly. ANNALES D'ENDOCRINOLOGIE 2012; 73:190-201. [PMID: 22682917 DOI: 10.1016/j.ando.2012.05.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2012] [Accepted: 05/01/2012] [Indexed: 01/09/2023]
Abstract
Acromegaly is a chronic rare disease associated with negative pathological effects on multiple systems and organs. We designed a new informatics tool to study data from patients with acromegaly, the Liege Acromegaly Survey (LAS). This relational database permits the inclusion of anonymous historical and prospective data on patients and includes pathophysiology, clinical features, responses to therapy and long term outcomes of acromegaly. We deployed the LAS in a validation study at a single center in order to study the characteristics of patients with acromegaly diagnosed at our center from 1970-2011. A total of 290 patients with acromegaly were included (147 males and 143 females). There was a linear relationship between age at diagnosis and the date of diagnosis, indicating that older patients are being diagnosed with acromegaly more frequently. A majority presented with macroadenomas (77.5%) and the median diameter was 14 mm. Patients with macroadenomas were significantly younger than patients with microadenomas (P=0.01). GH values at diagnosis decreased with the age of the patients (P=0.01) and there was a correlation between GH values and tumor size at diagnosis (P=0.02). No correlation existed between insulin-like growth factor 1 (IGF-1) levels and tumor characteristics. The prevalence of diabetes was 21.4% in this population and 41.0% had hypertension. The presence of hypertension and diabetes were significantly associated with one another (P<0.001). There was a linear relation between initial GH and IGF-1 levels at diagnosis and those obtained during SSA analog treatment and the lowest GH and IGF-1 values following SSA therapy were obtained in older patients (GH: P<0.001; IGF-1: P<0.001). The LAS is a new relational database that is feasible to use in the clinical research setting and permits ready pooling of anonymous patient data from multiple study sites to undertake robust statistical analyses of clinical and therapeutic characteristics.
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