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An İ, Kahraman FC, Bilgiç A, Aktürk AŞ, Albayrak H, Kartal D, Çınar SL, Solak SS, Uslu M, Şanlı HE, Yıldızhan İK, Şahin MT, Zindanci İ, Savaş S, Ayhan E, Cinel M, Ataş ENS, Aydemir M, Selek A, Elbüken G, Zuhur SS, Karaca Z, Bülbül BY, Ünübol M, Demir Ö, Hekimsoy Z, Tuna M, Asilsoy M, Çetin S. Cutaneous findings in patients with acromegaly and its relationship with concomitant endocrinopathies. Clin Endocrinol (Oxf) 2024; 101:255-262. [PMID: 38712950 DOI: 10.1111/cen.15071] [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: 01/23/2024] [Revised: 04/22/2024] [Accepted: 04/27/2024] [Indexed: 05/08/2024]
Abstract
OBJECTIVES Skin changes in acromegaly are often the first sign of the disease. The aim of this study was to describe the cutaneous findings in patients with acromegaly. In addition, a secondary aim was to investigate the possible association of these findings with remission status and concomitant endocrinopathies. DESIGN, PATIENTS, AND MEASUREMENTS In this prospective multicenter study, 278 patients over the age of 18 years with acromegaly who were followed up in 14 different tertiary healthcare institutions were included. These patients, who were followed up by the Endocrinology Department, were then referred to a dermatologist for dermatological examination. The frequency of skin lesions was investigated by detailed dermatologic examination. Dermatological diagnosis is reached by clinical, dermatological and/or dermoscopic examination, and rarely skin punch biopsy examinations in suspicious cases. The possible association of the skin findings between remitted and nonremitted patients and with concomitant endocrinopathies were evaluated. RESULTS The most common skin findings in patients with acromegaly in our study were skin tags (52.5%), cherry angiomas (47.4%), seborrhoea (37%), varicose veins (33%), acneiform lesions (28.8%), hyperhidrosis (26.9%) and hypertrichosis (18.3%). Hypertrichosis was significantly more prevalent in patients nonremitted (p: .001), while xerosis cutis was significantly more prevalent in patients remitted (p: .001). The frequency of diabetes mellitus and hypothyroidism was significantly higher in patients with varicose veins and seborrhoeic keratosis than those without. Additionally, the coexistence of hypothyroidism, hyperthyroidism and galactorrhea was significantly higher in patients with Cherry angioma than in those without Cherry angioma (p-values: .024, .034 and .027, respectively). The frequency of hypogonadism in those with xerosis cutis was significantly higher than in those without (p: .035). CONCLUSIONS Cutaneous androgenization findings such as skin tag, seborrhoea, acne and acanthosis nigricans are common in patients with acromegaly. Clinicians should be aware that skin findings associated with insulin resistance may develop in these patients. It can be said that the remission state in acromegaly has no curative effect on cutaneous findings. Only patients in remission were less likely to have hypertrichosis. This may allow earlier review of the follow-up and treatment of acromegaly patients presenting with complaints of hypertrichosis. Additionally, it can be said that patients with skin findings such as cherry angioma may be predisposed to a second endocrinopathy, especially hypothyroidism. Including dermatology in a multidisciplinary perspective in acromegaly patient management would be beneficial to detect cutaneous findings earlier.
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Affiliation(s)
- İsa An
- Department of Dermatology, Şanlıurfa Training and Research Hospital, Sanlıurfa, Turkey
| | - Filiz Cebeci Kahraman
- Department of Dermatology, Göztepe Prof. Dr. Süleyman Yalçın City Hospital, İstanbul, Turkey
| | - Aslı Bilgiç
- Department of Dermatology, Akdeniz University Medical Faculty, Antalya, Turkey
| | - Aysun Şikar Aktürk
- Department of Dermatology, Kocaeli University Medical Faculty, Kocaeli, Turkey
| | - Hülya Albayrak
- Department of Dermatology, Namık Kemal University Medical Faculty, Turkey
| | - Demet Kartal
- Department of Dermatology, Erciyes University Medical Faculty, Kayseri, Turkey
| | - Salih Levent Çınar
- Department of Dermatology, Erciyes University Medical Faculty, Kayseri, Turkey
| | | | - Meltem Uslu
- Department of Dermatology, Adnan Menderes University Medical Faculty, Turkey
| | - Hatice Erdi Şanlı
- Department of Dermatology, Ankara University Medical Faculty, Ankara, Turkey
| | | | - Mustafa Turhan Şahin
- Department of Dermatology, Celal Bayar University Medical Faculty, Manisa, Turkey
| | - İlkin Zindanci
- Department of Dermatology, Umraniye Training and Research Hospital, İstanbul, Turkey
| | - Sevil Savaş
- Department of Dermatology, İstanbul Training and Research Hospital, İstanbul, Turkey
| | - Erhan Ayhan
- Department of Dermatology, Gazi Yaşargil Training and Research Hospital, Diyarbakır, Turkey
| | - Murat Cinel
- Department of Endocrinology and Metabolism, Mehmet Akif Inan Education and Research Hospital, Şanlıurfa, Turkey
| | - Elif Nazlı Serin Ataş
- Department of Endocrinology and Metabolism, Akdeniz University Medical Faculty, Antalya, Turkey
| | - Mustafa Aydemir
- Department of Endocrinology and Metabolism, Akdeniz University Medical Faculty, Antalya, Turkey
| | - Alev Selek
- Department of Endocrinology and Metabolism, Kocaeli University Medical Faculty, Kocaeli, Turkey
| | - Gülşah Elbüken
- Department of Endocrinology and Metabolism, Namık Kemal University Medical Faculty, Turkey
| | - Sayid Shafi Zuhur
- Department of Endocrinology and Metabolism, Namık Kemal University Medical Faculty, Turkey
| | - Züleyha Karaca
- Department of Endocrinology and Metabolism, Erciyes University Medical Faculty, Kayseri, Turkey
| | - Buket Yılmaz Bülbül
- Department of Endocrinology and Metabolism, Trakya University Medical Faculty, Edirne, Turkey
| | - Mustafa Ünübol
- Department of Endocrinology and Metabolism, Adnan Menderes University Medical Faculty, Turkey
| | - Özgür Demir
- Department of Endocrinology and Metabolism, Ankara University Medical Faculty, Ankara, Turkey
| | - Zeliha Hekimsoy
- Department of Endocrinology and Metabolism, Celal Bayar University Medical Faculty, Manisa, Turkey
| | - Mazhar Tuna
- Department of Endocrinology and Metabolism, Umraniye Training and Research Hospital, İstanbul, Turkey
| | - Miray Asilsoy
- Department of Endocrinology and Metabolism, Sultan 2. Abdulhamid Han Training and Research Hospital, İstanbul, Turkey
| | - Sedat Çetin
- Department of Endocrinology and Metabolism, Gazi Yaşargil Training and Research Hospital, Diyarbakır, Turkey
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Marques-Pamies M, Gil J, Valassi E, Hernández M, Biagetti B, Giménez-Palop O, Martínez S, Carrato C, Pons L, Villar-Taibo R, Araujo-Castro M, Blanco C, Simón I, Simó-Servat A, Xifra G, Vázquez F, Pavón I, García-Centeno R, Zavala R, Hanzu FA, Mora M, Aulinas A, Vilarrasa N, Librizzi S, Calatayud M, de Miguel P, Alvarez-Escola C, Picó A, Sampedro M, Salinas I, Fajardo-Montañana C, Cámara R, Bernabéu I, Jordà M, Webb SM, Marazuela M, Puig-Domingo M. Revisiting the usefulness of the short acute octreotide test to predict treatment outcomes in acromegaly. Front Endocrinol (Lausanne) 2023; 14:1269787. [PMID: 38027102 PMCID: PMC10654626 DOI: 10.3389/fendo.2023.1269787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 10/11/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction We previously described that a short version of the acute octreotide test (sAOT) can predict the response to first-generation somatostatin receptor ligands (SRLs) in patients with acromegaly. We have prospectively reassessed the sAOT in patients from the ACROFAST study using current ultra-sensitive GH assays. We also studied the correlation of sAOT with tumor expression of E-cadherin and somatostatin receptor 2 (SSTR2) . Methods A total of 47 patients treated with SRLs for 6 months were evaluated with the sAOT at diagnosis and correlated with SRLs' response. Those patients whose IGF1 decreased to <3SDS from normal value were considered responders and those whose IGF1 was ≥3SDS, were considered non-responders. The 2 hours GH value (GH2h) after s.c. administration of 100 mcg of octreotide was used to define predictive cutoffs. E-cadherin and SSTR2 immunostaining in somatotropinoma tissue were investigated in 24/47 and 18/47 patients, respectively. Results In all, 30 patients were responders and 17 were non-responders. GH2h was 0.68 (0.25-1.98) ng/mL in responders vs 2.35 (1.59-9.37) ng/mL in non-responders (p<0.001). GH2h = 1.4ng/mL showed the highest ability to identify responders (accuracy of 81%, sensitivity of 73.3%, and specificity of 94.1%). GH2h = 4.3ng/mL was the best cutoff for non-response prediction (accuracy of 74%, sensitivity of 35.3%, and specificity of 96.7%). Patients with E-cadherin-positive tumors showed a lower GH2h than those with E-cadherin-negative tumors [0.9 (0.3-2.1) vs 3.3 (1.5-12.1) ng/mL; p<0.01], and patients with positive E-cadherin presented a higher score of SSTR2 (7.5 ± 4.2 vs 3.3 ± 2.1; p=0.01). Conclusion The sAOT is a good predictor tool for assessing response to SRLs and correlates with tumor E-cadherin and SSTR2 expression. Thus, it can be useful in clinical practice for therapeutic decision-making in patients with acromegaly.
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Affiliation(s)
| | - Joan Gil
- Endocrine Research Unit, Germans Trias i Pujol Research Institute (IGTP), Badalona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBER-ER, Unidad 747), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
| | - Elena Valassi
- Endocrine Research Unit, Germans Trias i Pujol Research Institute (IGTP), Badalona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBER-ER, Unidad 747), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
- Department of Endocrinology and Nutrition, Germans Trias i Pujol University Hospital, Badalona, Spain
| | - Marta Hernández
- Department of Endocrinology and Nutrition, Arnau de Vilanova University Hospital, Lleida, Spain
- Endocrine Research Unit, Lleida Institute for Biomedical Research Dr. Pifarré Foundation (IRBLleida), Lleida, Spain
| | - Betina Biagetti
- Department of Endocrinology and Nutrition, Vall Hebron University Hospital, Barcelona, Spain
| | - Olga Giménez-Palop
- Department of Endocrinology and Nutrition, Parc Taulí University Hospital, Sabadell, Spain
| | - Silvia Martínez
- Department Hormonal Laboratory, Germans Trias i Pujol University Hospital, Badalona, Spain
| | - Cristina Carrato
- Department of Pathology, Germans Trias i Pujol University Hospital, Badalona, Spain
| | - Laura Pons
- Department of Pathology, Germans Trias i Pujol University Hospital, Badalona, Spain
| | - Rocío Villar-Taibo
- Department of Endocrinology and Nutrition, Clínico de Santiago University Hospital, Santiago de Compostela, Spain
| | - Marta Araujo-Castro
- Department of Endocrinology and Nutrition, Ramón y Cajal University Hospital, Madrid, Spain
| | - Concepción Blanco
- Department of Endocrinology and Nutrition, Príncipe de Asturias University Hospital, Madrid, Spain
| | - Inmaculada Simón
- Department of Endocrinology and Nutrition, Joan XXIII University Hospital, Tarragona, Spain
| | - Andreu Simó-Servat
- Department of Endocrinology and Nutrition, Mutua de Terrassa University Hospital, Terrassa, Spain
| | - Gemma Xifra
- Department of Endocrinology and Nutrition, Josep Trueta University Hospital, Girona, Spain
| | - Federico Vázquez
- Department of Endocrinology and Nutrition, Germans Trias i Pujol University Hospital, Badalona, Spain
| | - Isabel Pavón
- Department of Endocrinology and Nutrition, Getafe University Hospital, Madrid, Spain
| | - Rogelio García-Centeno
- Department of Endocrinology and Nutrition, Gregorio Marañón University Hospital, Madrid, Spain
| | - Roxana Zavala
- Department of Endocrinology and Nutrition, Joan XXIII University Hospital, Tarragona, Spain
| | - Felicia Alexandra Hanzu
- Department of Endocrinology and Nutrition, Hospital Clinic University Hospital, Barcelona, Spain
- Endocrine Research Unit, Institut d’Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Mireia Mora
- Department of Endocrinology and Nutrition, Hospital Clinic University Hospital, Barcelona, Spain
- Endocrine Research Unit, Institut d’Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Anna Aulinas
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBER-ER, Unidad 747), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
- Department of Endocrinology and Nutrition, Hospital Sant Pau, Barcelona, Spain
- Universitat Autònoma de Barcelona (UAB), Departament de Medicina, Barcelona, Spain
| | - Nuria Vilarrasa
- Department of Endocrinology and Nutrition, Bellvitge University Hospital, Bellvitge, Spain
- Endocrine Research Unit, Institut d’Investigació Biomèdica de Bellvitge (IDIBELL), Bellvitge, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Soledad Librizzi
- Department of Endocrinology and Nutrition, 12 de Octubre University Hospital, Madrid, Spain
| | - María Calatayud
- Department of Endocrinology and Nutrition, 12 de Octubre University Hospital, Madrid, Spain
| | - Paz de Miguel
- Department of Endocrinology and Nutrition, Clínico San Carlos University Hospital, Madrid, Spain
| | | | - Antonio Picó
- Department of Endocrinology and Nutrition, General University Hospital Dr Balmis, Miguel Hernández University, Alicante, Spain
- Endocrine Research Unit, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
| | - Miguel Sampedro
- Department of Endocrinology and Nutrition, La Princesa University Hospital, Madrid, Spain
| | - Isabel Salinas
- Department of Endocrinology and Nutrition, Germans Trias i Pujol University Hospital, Badalona, Spain
| | | | - Rosa Cámara
- Department of Endocrinology and Nutrition, La Fe University Hospital, Valencia, Spain
| | - Ignacio Bernabéu
- Department of Endocrinology and Nutrition, Clínico de Santiago University Hospital, Santiago de Compostela, Spain
| | - Mireia Jordà
- Endocrine Research Unit, Germans Trias i Pujol Research Institute (IGTP), Badalona, Spain
| | - Susan M. Webb
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBER-ER, Unidad 747), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
- Department of Endocrinology and Nutrition, Hospital Sant Pau, Barcelona, Spain
- Universitat Autònoma de Barcelona (UAB), Departament de Medicina, Barcelona, Spain
| | - Mónica Marazuela
- Department of Endocrinology and Nutrition, La Princesa University Hospital, Madrid, Spain
| | - Manel Puig-Domingo
- Endocrine Research Unit, Germans Trias i Pujol Research Institute (IGTP), Badalona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBER-ER, Unidad 747), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
- Department of Endocrinology and Nutrition, Germans Trias i Pujol University Hospital, Badalona, Spain
- Universitat Autònoma de Barcelona (UAB), Departament de Medicina, Barcelona, Spain
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3
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Marazuela M, Blanco C, Bernabeu I, Menendez E, Villar R, Paja M, Sampedro-Nuñez M, Samaniego ML, Díaz-Muñoz M, Sánchez-Cenizo L. Acromegaly disease activity according to ACRODAT®, a cross-sectional study in Spain: ACROVAL study. Endocrine 2022; 75:525-536. [PMID: 34668173 PMCID: PMC8816757 DOI: 10.1007/s12020-021-02900-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 10/04/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To evaluate disease activity status using the Acromegaly Disease Activity Tool (ACRODAT®) in a cohort of Spanish acromegaly patients, to assess the relationship between the level of disease activity according to both ACRODAT® and the physicians' clinical evaluation, and to study the potential discrepancies in the perception of symptoms between physicians and patients. DESIGN Multicenter, observational, descriptive and cross-sectional study. METHODS Disease activity was assessed in adult patients with acromegaly under pharmacological treatment during at least 6 months using ACRODAT®. RESULTS According to ACRODAT®, 48.2%, 31.8% and 20.0% of a total of 111 patients were classified as having a stable disease (S), mild disease activity (M-DA) and significant disease activity (S-DA) respectively. ACRODAT® classification of disease activity significantly correlated with physicians' opinion, with a moderate inter-rater agreement and a specificity of 92.45% (PPV = 86.21%). No correlation was found between IGF-I levels and severity of symptoms or quality of life (QoL). A decision to take clinical action was significantly more frequent in S-DA and M-DA patients than S patients but no action was taken on 5 (22.7%) and 27 (77.1%) S-DA and M-DA patients, respectively CONCLUSIONS: ACRODAT® detected disease activity in 51.8% of patients. Interestingly, although M-DA and S-DA patients were likely to be in the process of being controlled, action was not always taken on these patients. ACRODAT® is a validated and highly specific tool that may be useful to routinely monitor acromegaly and to identify patients with non-obvious disease activity by incorporating "patient-centred" parameters like symptoms and QoL to the clinical evaluation of acromegaly.
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Affiliation(s)
- Mónica Marazuela
- Hospital Universitario de La Princesa, Madrid, Universidad Autónoma de Madrid, Madrid, Spain
| | - Concepción Blanco
- Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
| | - Ignacio Bernabeu
- Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, La Coruña, Spain
| | - Edelmiro Menendez
- Hospital Universitario Central de Asturias (HUCA), Instituto de investigación del Principado de Asturias (ISPA), Oviedo, Asturias, Spain
| | - Rocío Villar
- Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, La Coruña, Spain
| | - Miguel Paja
- Hospital Universitario de Basurto, Bilbao, Vizcaya, Spain
| | - Miguel Sampedro-Nuñez
- Hospital Universitario de La Princesa, Madrid, Universidad Autónoma de Madrid, Madrid, Spain
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García-Casares N, Fernández-Andújar M, González-Molero I, Maraver-Selfa S, Gutiérrez-Bedmar M, Ramos-Rodriguez JR, Alfaro-Rubio F, Roé-Vellvé N, Garcia-Garcia I, García-Arnés JA. Cognitive Functioning and Cortical Brain Thickness in Acromegaly Patients: A Pilot study. Arch Clin Neuropsychol 2021; 36:780-790. [PMID: 33200172 DOI: 10.1093/arclin/acaa106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 09/12/2020] [Accepted: 10/01/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Cognitive effects in acromegaly patients are poorly understood and the mechanisms involved are still unclear. The aim of this study was to evaluate the cognitive function, depression, and quality of life of acromegaly patients treated with pegvisomant versus somatostatin analogues (SRLs) and to analyze the effect of the different treatments on cognition and possible structural brain changes. METHODS This cross-sectional study involved 23 acromegaly patients divided into two groups according to treatment modality: One group of 9 patients treated with pegvisomant and another group of 14 patients treated with SRLs. All participants underwent blood analysis, neuropsychological tests, depression tests, quality of life assessment, and 3-Tesla magnetic resonance imaging. RESULTS We found no significant differences between groups in the neuropsychological tests, depression or quality of life; nor in the whole-brain cortical thickness. In the SRL group, the volume of the thalamus correlated positively with executive function, a correlation not found in the pegvisomant group. In addition, the pegvisomant group had significantly higher levels of insulin than the SRL group. CONCLUSIONS In conclusion, in this pilot study, the type of pharmacological treatment in patients with acromegaly and good glycemic control did not influence the cognitive function and cortical brain thickness. However, pegvisomant could play a neuroprotective role on the thalamus that will have to be demonstrated with larger samples in future studies.
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Affiliation(s)
- Natalia García-Casares
- Department of Medicine, Faculty of Medicine, University of Malaga, Málaga, Spain.,Centro de Investigaciones Médico-Sanitarias (C.I.M.E.S), University of Malaga, Málaga, Spain.,Área de Enfermedades cardiovasculares, obesidad y diabetes, Instituto de Investigación Biomédica de Málaga (IBIMA), Malaga, Spain
| | - Marina Fernández-Andújar
- Universitat Abat Oliba CEU, CEU Universities, Facultad de Ciencias Sociales, Departamento Psicología
| | | | - Silvia Maraver-Selfa
- Department of Endocrinology, Virgen de la Victoria University Hospital, Malaga, Spain
| | | | - José R Ramos-Rodriguez
- Centro de Investigaciones Médico-Sanitarias (C.I.M.E.S), University of Malaga, Málaga, Spain
| | - Francisco Alfaro-Rubio
- Centro de Investigaciones Médico-Sanitarias (C.I.M.E.S), University of Malaga, Málaga, Spain
| | - Nuria Roé-Vellvé
- Centro de Investigaciones Médico-Sanitarias (C.I.M.E.S), University of Malaga, Málaga, Spain
| | - Isabel Garcia-Garcia
- Department of Clinical Psychology and Psychobiology, Faculty of Psychology, University of Barcelona, Barcelona, Spain
| | - Juan A García-Arnés
- Department of Endocrinology, Regional University Hospital of Malaga, Malaga, Spain.,Department of Pharmacology, Faculty of Medicine, University of Malaga, Malaga, Spain
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Araujo-Castro M, Pascual-Corrales E, Martínez-Vaello V, Baonza Saiz G, Quiñones de Silva J, Acitores Cancela A, García Cano AM, Rodríguez Berrocal V. Predictive model of surgical remission in acromegaly: age, presurgical GH levels and Knosp grade as the best predictors of surgical remission. J Endocrinol Invest 2021; 44:183-193. [PMID: 32441006 DOI: 10.1007/s40618-020-01296-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 05/11/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE To identify presurgical clinical, hormonal and radiological variables associated with surgical remission in acromegaly and develop a predictive model for surgical remission. METHODS Ambispective study of acromegaly surgical patients followed in two Spanish tertiary hospitals. Patients operated by the same neurosurgeon by endonasal endoscopic transsphenoidal approach (n = 49) were included to develop the predictive model, and patients operated by other neurosurgeons (n = 37) were used for external validation of the predictive model. The predictive model was developed with a multivariate logistic regression model based on the 2000 criteria. RESULTS 86 acromegalic patients were included. 49 patients, 83.7% with macroadenomas and 32.7% with Knosp grade > 2, were included for the development of the predictive model. The overall rate of surgical remission with the 2000 criteria was 73.5% and 51.0% with the 2010 criteria. Using the 2000 criteria, variables associated with surgical remission were: older age (OR = 1.1, p = 0.001), lower basal presurgical GH levels (OR = 0.9, p = 0.003), Knosp 0-2 (OR = 34.1, p < 0.0001) and lower maximum pituitary adenoma diameter (OR = 0.9, p = 0.019). The model with the best diagnostic accuracy to predict surgical remission combined age, Knosp 0-2 and presurgical GH levels (AIC = 29.7, AUC = 0.95) with a sensitivity of 93.8% and a specificity of 75.0%. The estimated loss of prediction with the external validation (n = 37) was 4.2%. CONCLUSION The predictive model with the best diagnosis accuracy for surgical remission combined age, Knosp 0-2 and presurgical GH levels, with a sensitivity of 93.8% and a specificity of 75.0%. This model could be very useful to select candidates to preoperative medical treatment and planning the follow-up.
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Affiliation(s)
- M Araujo-Castro
- Neuroendocrinology Unit, Department of Endocrinology and Nutrition, Hospital Universitario Ramón y Cajal, Madrid, Spain.
| | - E Pascual-Corrales
- Neuroendocrinology Unit, Department of Endocrinology and Nutrition, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - V Martínez-Vaello
- Neuroendocrinology Unit, Department of Endocrinology and Nutrition, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - G Baonza Saiz
- Neuroendocrinology Unit, Department of Endocrinology and Nutrition, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - J Quiñones de Silva
- Neuroendocrinology Unit, Department of Endocrinology and Nutrition, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - A Acitores Cancela
- Neuroendocrinology Unit, Department of Neurosurgery, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - A M García Cano
- Hormones and Tumors Markers Unit, Department of Biochemistry, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - V Rodríguez Berrocal
- Neuroendocrinology Unit, Department of Neurosurgery, Hospital Universitario Ramón y Cajal, Madrid, Spain
- Endoscopic Skull Base Unit, Department of Neurosurgery, Hospital Universitario HM Puerta del Sur, Madrid, Spain
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de Pablos-Velasco P, Venegas EM, Álvarez Escolá C, Fajardo C, de Miguel P, González N, Bernabéu I, Valdés N, Paja M, Díez JJ, Biagetti B. Diagnosis, treatment and follow-up of patients with acromegaly in a clinical practice setting in Spain: the ACROPRAXIS program Delphi survey. Pituitary 2020; 23:129-139. [PMID: 31823249 PMCID: PMC7066268 DOI: 10.1007/s11102-019-01012-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
AIM The ACROPRAXIS program aims to describe the management of acromegaly in Spain and provide guidance. METHODS Ninety-three endocrinologists were organized into 13 panels to discuss the practical issues in managing acromegaly. Based on the key learnings, an online Delphi survey with 62 statements was performed, so those statements achieving consensus could be used as guidance. Statements were rated on a 9-point scale (9, full agreement; consensus > 66.6% of response in the same tertile). RESULTS Ninety-two endocrinologists (98.8%) answered two rounds of the survey (mean age 47.6 years; 59.8% women; median 18.5 years of experience). Consensus was achieved for 49 (79%) statements. DIAGNOSIS The levels of insulin-like growth factor I (IGFI) is the preferred screening test. If IGFI levels 1-1.3 ULN, the test is repeated and growth hormone (GH) after oral glucose tolerance test (OGTT) is assessed. A pituitary magnetic resonance is performed after biochemical diagnosis. TREATMENT Surgery is the first treatment choice for patients with microadenoma or macroadenoma with/without optical pathway compression. Pre-surgical somatostatin analogues (SSA) are indicated when surgery is delayed and/or to reduce anaesthesia-associated risks. After unsuccessful surgery, reintervention is performed if the residual tumor is resectable, while if non-resectable, SSA are administered. Follow-up First biochemical and clinical controls are performed 1-3 months after surgery. Disease remission is considered if random GH levels are < 1 µg/L or OGTT is < 1 or ≤ 0.4 µg/L, depending on the assay's sensitivity. CONCLUSION Current clinical management for acromegaly is homogeneous across Spain and generally follows clinical guidelines.
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Affiliation(s)
- Pedro de Pablos-Velasco
- Endocrinology Service, Hospital Universitario de Gran Canaria Dr. Negrín, C/Barranco de la Ballena, s/n, 35010, Las Palmas de Gran Canaria, Spain.
| | - Eva María Venegas
- Endocrinology Service, Hospital Universitario Virgen del Rocío, Seville, Spain
| | | | - Carmen Fajardo
- Endocrinology Service, Hospital Universitario de La Ribera, Valencia, Spain
| | - Paz de Miguel
- Endocrinology Service, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - Natividad González
- Endocrinology Service, Hospital Universitario Virgen Macarena, Seville, Spain
| | - Ignacio Bernabéu
- Endocrinology Service, Hospital Clínico Universitario Santiago de Compostela, Santiago de Compostela, Spain
| | - Nuria Valdés
- Endocrinology Service, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Miguel Paja
- Endocrinology Service, Hospital Universitario de Basurto, Bilbao, Spain
| | - Juan José Díez
- Endocrinology Service, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Betina Biagetti
- Endocrinology Service, Hospital Universitario Vall d'Hebrón, Barcelona, Spain
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7
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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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8
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The effectiveness of a therapist-oriented home rehabilitation program for a patient with acromegaly: A case study. J Bodyw Mov Ther 2019; 23:634-642. [PMID: 31563382 DOI: 10.1016/j.jbmt.2019.01.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 01/24/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND Acromegaly causes numerous functional limitations that negatively impact patients' performance of activities of daily living (ADLs) and contribute to the deterioration of health-related quality of life (HRQoL). Thus, the purpose of the present case study was to evaluate the effect of therapist-oriented home rehabilitation (TOHR) for a patient with acromegaly. CASE DESCRIPTION We report the case of a 53-year-old man who was diagnosed with primary acromegaly 17 years ago. He complained of difficulties performing tasks that involved his hands, pain in the lower limbs, and fatigue when he climbed a few flights of stairs. Although he performed ADLs independently, he reported some difficulties or discomfort when performing them. INTERVENTION AND OUTCOME The patient underwent a booklet-guided physical exercise program that lasted two months (three times per week, 60 minutes per session). The activities included overall stretching, muscle strengthening, and endurance exercises, along with aerobic conditioning through functional circuit training. After two months of exercise, he reported improved HRQoL as assessed with the Acromegaly Quality of Life Questionnaire, with increases in quadriceps muscle strength and 6-min walking distance. However, none of these benefits remained when the patient was assessed after a 1-month washout period. CONCLUSION This study showed that patients with acromegaly may benefit markedly from TOHR, which could provide a novel therapeutic approach as an adjunct to hormone control therapy.
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9
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Bernabeu I, Cámara R, Marazuela M, Puig Domingo M. Documento de expertos sobre el manejo de la acromegalia. ENDOCRINOL DIAB NUTR 2018; 65:428-437. [DOI: 10.1016/j.endinu.2018.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 05/03/2018] [Accepted: 05/04/2018] [Indexed: 11/26/2022]
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10
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Gokosmanoglu F, Onmez A. Clinical assessment of patients with acromegaly. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2018; 23:61. [PMID: 30181743 PMCID: PMC6091129 DOI: 10.4103/jrms.jrms_139_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 01/13/2018] [Accepted: 05/09/2018] [Indexed: 11/29/2022]
Abstract
Background: In this study, we aimed to retrospectively evaluate treatment outcomes and treatment methods in acromegaly patients. Materials and Methods: The study included 65 acromegaly patients followed in Sakarya University Faculty of Medicine Department of Endocrinology in Turkey between 2004 and 2013. Clinical, biochemical, and radiological data were obtained retrospectively from the medical files of the patients. All cases have been discussed in the endocrinology and pituitary surgery council, and a multidisciplinary treatment approach had been chosen in management. Results: Sixty-five patients were included in the study. Of the patients, 57% were female. Mean age was 45.3 ± 9.2 years old. Of the cases, 12.3% were microadenomas (n = 8, tumor diameter <10 mm) and 87.6% were macroadenomas (n = 57, tumor diameter ≥10 mm). In our study, 70% remission was achieved with the first operation and medical treatment. Patients with invasive acromegaly without remission after the first operation underwent reoperation, medical treatment, and conventional or stereotactic radiotherapy and achieved 45% remission rate. Conclusion: Pituitary surgery is the first treatment option for acromegaly. In patients who could not be remissioned after the first operation, remission can be achieved by combined therapy consist of reoperation, medical treatment, and conventional or stereotactic radiotherapy.
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Affiliation(s)
- Feyzi Gokosmanoglu
- Department of Endocrinology, Sakarya University Medicine Faculty, Sakarya, Turkey
| | - Attila Onmez
- Department of Internal Medicine, Duzce University Medicine Faculty, Duzce, Turkey
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11
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Iglesias P, Rodríguez Berrocal V, Díez JJ. Giant pituitary adenoma: histological types, clinical features and therapeutic approaches. Endocrine 2018; 61:407-421. [PMID: 29909598 DOI: 10.1007/s12020-018-1645-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Accepted: 05/29/2018] [Indexed: 12/23/2022]
Abstract
Giant pituitary adenomas comprise about 6-10% of all pituitary tumors. They are mostly clinically non-functioning adenomas and occur predominantly in males. The presenting symptoms are usually secondary to compression of neighboring structures, but also due to partial or total hypopituitarism. Functioning adenomas give rise to specific symptoms of hormonal hypersecretion. The use of dopamine agonists is considered a first-line treatment in patients with giant macroprolactinomas. Somatostatin analogs can also be used as primary treatment in cases of growth hormone and thyrotropin producing giant adenomas, although remission of the disease is not achieved in the vast majority of these patients. Neurosurgical treatment, either through transsphenoidal or transcranial surgery, continues to be the treatment of choice in the majority of patients with giant pituitary adenomas. The intrinsic complexity of these tumors requires the use of different therapies in a combined or sequential way. A multimodal approach and a therapeutic strategy involving a multidisciplinary team of expert professionals form the basis of the therapeutic success in these patients.
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Affiliation(s)
- Pedro Iglesias
- Department of Endocrinology. Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain.
| | | | - Juan José Díez
- Department of Endocrinology. Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
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12
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Abstract
Acromegaly is an uncommon, chronic disease, characterized by hypersecretion of a pituitary growth hormone by somatotroph adenomas, along with increased levels of insulin-like growth factor-1. Although acromegaly presents a wide array of clinical manifestations, the salient symptoms include acral and soft tissue enlargement, joint pain, heart and respiratory failure, diabetes mellitus, and hypertension, leading to increased morbidity and mortality. Hence, early diagnosis of the disease is critical to enhance life expectancy and quality of life. New approaches are being developed for diagnosis and surveillance (both screening and follow-up), including sensitive biochemical assays and the use of MRI to visualize extremely small tumors, and are helpful in the early diagnosis of acromegaly, subsequent treatment, and disease control. This mini-review summarizes the most common and effective tools used in the diagnosis of acromegaly.
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Affiliation(s)
- Salma AlDallal
- Haematology & Blood Bank Department, Amiri Hospital, Kuwait Ministry of Health, Sharq, Kuwait,
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13
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Criterios para el diagnóstico y el control poscirugía de la acromegalia, y el cribado y el manejo de sus comorbilidades: recomendaciones de expertos. ENDOCRINOL DIAB NUTR 2018; 65:297-305. [DOI: 10.1016/j.endinu.2018.01.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 01/22/2018] [Accepted: 01/25/2018] [Indexed: 12/29/2022]
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14
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Alhambra-Expósito MR, Ibáñez-Costa A, Moreno-Moreno P, Rivero-Cortés E, Vázquez-Borrego MC, Blanco-Acevedo C, Toledano-Delgado Á, Lombardo-Galera MS, Vallejo-Casas JA, Gahete MD, Castaño JP, Gálvez MA, Luque RM. Association between radiological parameters and clinical and molecular characteristics in human somatotropinomas. Sci Rep 2018; 8:6173. [PMID: 29670116 PMCID: PMC5906631 DOI: 10.1038/s41598-018-24260-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 03/09/2018] [Indexed: 02/08/2023] Open
Abstract
Acromegaly is a rare but severe disease, originated in 95% of cases by a growth hormone-secreting adenoma (somatotropinoma) in the pituitary. Magnetic resonance imaging (MRI) is a non-invasive technique used for the diagnosis and prognosis of pituitary tumours. The aim of this study was to determine whether the use of T2-weighted signal intensity at MRI could help to improve the characterisation of somatotropinomas, by analysing its relationship with clinical/molecular features. An observational study was implemented in a cohort of 22 patients (mean age = 42.1 ± 17.2 years; 59% women; 95% size>10 mm). Suprasellar-extended somatotropinomas presented larger diameters vs. non-extended tumours. T2-imaging revealed that 59% of tumours were hyperintense and 41% isointense adenomas, wherein hyperintense were more invasive (according to Knosp-score) than isointense adenomas. A higher proportion of hyperintense somatotropinomas presented extrasellar-growth, suprasellar-growth and invasion of the cavernous sinus compared to isointense adenomas. Interestingly, somatostatin receptor-3 and dopamine receptor-5 (DRD5) expression levels were associated with extrasellar and/or suprasellar extension. Additionally, DRD5 was also higher in hyperintense adenomas and its expression was directly correlated with Knosp-score and with tumour diameter. Hence, T2-weighted MRI on somatotropinomas represents a potential tool to refine their diagnosis and prognosis, and could support the election of preoperative treatment, when required.
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Affiliation(s)
- María R Alhambra-Expósito
- Maimonides Institute of Biomedical Research of Cordoba, Córdoba, 14004, Spain.,Reina Sofia University Hospital (HURS), Córdoba, 14004, Spain.,Service of Endocrinology and Nutrition, HURS, Córdoba, 14004, Spain
| | - Alejandro Ibáñez-Costa
- Maimonides Institute of Biomedical Research of Cordoba, Córdoba, 14004, Spain.,Reina Sofia University Hospital (HURS), Córdoba, 14004, Spain.,Department of Cell Biology, Physiology and Immunology, Universidad de Córdoba, Córdoba, 14004, Spain.,CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), Córdoba, 14004, Spain.,Campus de Excelencia Internacional Agroalimentario (ceiA3), Córdoba, 14004, Spain
| | - Paloma Moreno-Moreno
- Maimonides Institute of Biomedical Research of Cordoba, Córdoba, 14004, Spain.,Reina Sofia University Hospital (HURS), Córdoba, 14004, Spain.,Service of Endocrinology and Nutrition, HURS, Córdoba, 14004, Spain
| | - Esther Rivero-Cortés
- Maimonides Institute of Biomedical Research of Cordoba, Córdoba, 14004, Spain.,Reina Sofia University Hospital (HURS), Córdoba, 14004, Spain.,Department of Cell Biology, Physiology and Immunology, Universidad de Córdoba, Córdoba, 14004, Spain.,CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), Córdoba, 14004, Spain.,Campus de Excelencia Internacional Agroalimentario (ceiA3), Córdoba, 14004, Spain
| | - Mari C Vázquez-Borrego
- Maimonides Institute of Biomedical Research of Cordoba, Córdoba, 14004, Spain.,Reina Sofia University Hospital (HURS), Córdoba, 14004, Spain.,Department of Cell Biology, Physiology and Immunology, Universidad de Córdoba, Córdoba, 14004, Spain.,CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), Córdoba, 14004, Spain.,Campus de Excelencia Internacional Agroalimentario (ceiA3), Córdoba, 14004, Spain
| | - Cristóbal Blanco-Acevedo
- Maimonides Institute of Biomedical Research of Cordoba, Córdoba, 14004, Spain.,Reina Sofia University Hospital (HURS), Córdoba, 14004, Spain.,Service of Neurosurgery, HURS, Córdoba, 14004, Spain
| | - Álvaro Toledano-Delgado
- Maimonides Institute of Biomedical Research of Cordoba, Córdoba, 14004, Spain.,Reina Sofia University Hospital (HURS), Córdoba, 14004, Spain.,Service of Neurosurgery, HURS, Córdoba, 14004, Spain
| | | | | | - Manuel D Gahete
- Maimonides Institute of Biomedical Research of Cordoba, Córdoba, 14004, Spain.,Reina Sofia University Hospital (HURS), Córdoba, 14004, Spain.,Department of Cell Biology, Physiology and Immunology, Universidad de Córdoba, Córdoba, 14004, Spain.,CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), Córdoba, 14004, Spain.,Campus de Excelencia Internacional Agroalimentario (ceiA3), Córdoba, 14004, Spain
| | - Justo P Castaño
- Maimonides Institute of Biomedical Research of Cordoba, Córdoba, 14004, Spain. .,Reina Sofia University Hospital (HURS), Córdoba, 14004, Spain. .,Department of Cell Biology, Physiology and Immunology, Universidad de Córdoba, Córdoba, 14004, Spain. .,CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), Córdoba, 14004, Spain. .,Campus de Excelencia Internacional Agroalimentario (ceiA3), Córdoba, 14004, Spain.
| | - María A Gálvez
- Maimonides Institute of Biomedical Research of Cordoba, Córdoba, 14004, Spain. .,Reina Sofia University Hospital (HURS), Córdoba, 14004, Spain. .,Service of Endocrinology and Nutrition, HURS, Córdoba, 14004, Spain.
| | - Raúl M Luque
- Maimonides Institute of Biomedical Research of Cordoba, Córdoba, 14004, Spain. .,Reina Sofia University Hospital (HURS), Córdoba, 14004, Spain. .,Department of Cell Biology, Physiology and Immunology, Universidad de Córdoba, Córdoba, 14004, Spain. .,CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), Córdoba, 14004, Spain. .,Campus de Excelencia Internacional Agroalimentario (ceiA3), Córdoba, 14004, Spain.
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15
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Puig-Domingo M, Soto A, Venegas E, Vilchez R, Blanco C, Cordido F, Lucas T, Marazuela M, Casany R, Cuatrecasas G, Fajardo C, Gálvez MÁ, Maraver S, Martín T, Romero E, Paja M, Picó A, Bernabeu I, Resmini E. Use of lanreotide in combination with cabergoline or pegvisomant in patients with acromegaly in the clinical practice: The ACROCOMB study. ACTA ACUST UNITED AC 2016; 63:397-408. [DOI: 10.1016/j.endonu.2016.05.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 05/24/2016] [Accepted: 05/26/2016] [Indexed: 12/27/2022]
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16
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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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17
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Kasuki L, Volschan I, Gadelha MR. Evidence-based guidelines in acromegaly: implications on the clinic. Expert Rev Endocrinol Metab 2016; 11:171-175. [PMID: 30058867 DOI: 10.1586/17446651.2016.1145051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Acromegaly is a rare disease with many challenges in its management. In order to address these challenges, many clinical practice guidelines were recently published. They were based on the literature evidence, aiming at guiding primary care physicians, general endocrinologists and neuroendocrinologists. The majority of these guidelines were developed following the GRADE system that classifies the recommendations according to strength (weak or strong) and quality of the evidence that supports them. In this review, we discuss how the evidence-based guidelines are developed, how to interpret the different strengths of recommendations and discuss the clinical implications of the evidence-based guidelines in acromegaly, pointing its utility and limitations on the diagnosis, management of comorbidities and in the disease treatment.
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Affiliation(s)
- Leandro Kasuki
- a Endocrine Section - Medical School and Hospital Universitário Clementino Fraga Filho , Universidade Federal do Rio de Janeiro , Rio de Janeiro , Brazil
- b Neuroendocrine Section , Instituto Estadual do Cérebro Paulo Niemeyer , Rio de Janeiro , Brazil
| | - Isabela Volschan
- c Cardiology Section - Medical School and Hospital Universitário Clementino Fraga Filho , Universidade Federal do Rio de Janeiro , Rio de Janeiro , Brazil
| | - Mônica R Gadelha
- a Endocrine Section - Medical School and Hospital Universitário Clementino Fraga Filho , Universidade Federal do Rio de Janeiro , Rio de Janeiro , Brazil
- b Neuroendocrine Section , Instituto Estadual do Cérebro Paulo Niemeyer , Rio de Janeiro , Brazil
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18
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Rosario PW, Calsolari MR. Laboratory investigation of acromegaly: is basal or random GH > 0.4 µg/L in the presence of normal serum IGF-1 an important result? ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2015; 59:54-8. [PMID: 25926115 DOI: 10.1590/2359-3997000000010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Accepted: 10/24/2014] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To determine the frequency of indication of the GH suppression test and pituitary magnetic resonance imaging (MRI) in patients with clinical suspicion of acromegaly with GH concentrations > 0.4 µg/L despite normal serum IGF-1. SUBJECTS AND METHODS A total of 160 patients with clinical suspicion of acromegaly with normal IGF-1 were studied. RESULTS Basal GH > 0.4 µg/L was observed in 70/88 women (79.5%). Nadir GH > 0.4 µg/L was found in 21/70 women (30%) and these patients were submitted to MRI, which revealed a microadenoma in 2/21 women (9.5%). In these two women, IGF-1 continued to be normal in subsequent measurements and no clinical progression has been observed so far (time of follow-up until now 4 years). Basal GH > 0.4 µg/L was seen in 33/72 men (45.8%). Nadir GH was < 0.4 µg/L in all of them. CONCLUSIONS In patients with clinical suspicion of acromegaly, concern over GH concentration in the presence of normal IGF-1 results in the unwarranted complementary investigation in many cases, and even in possible equivocal diagnoses. It is only in exceptional cases that normal IGF-1 should not rule out acromegaly.
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Torales J, Halperin I, Hanzu F, Mora M, Alobid I, De Notaris M, Ferrer E, Enseñat J. Endoscopic endonasal surgery for pituitary tumors. Results in a series of 121 patients operated at the same center and by the same neurosurgeon. ACTA ACUST UNITED AC 2014; 61:410-6. [PMID: 24857341 DOI: 10.1016/j.endonu.2014.03.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Revised: 03/12/2014] [Accepted: 03/18/2014] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Pituitary adenomas account for approximately 15% of intracranial benign tumors. The neurosurgical results achieved since the endoscopic endonasal transsphenoidal (EET) approach was introduced in our center in 2005 are reported here. PATIENTS AND METHODS A retrospective analysis of 121 patients with sellar lesions (58% females, age 55.7 ± 16 years, range 18-82) who underwent EET surgery from February 2005 to January 2012 and were followed up for a mean time of 4.58 years (range 1.08-8.58). RESULTS Six Rathke cleft cysts (3 intra-suprasellar, 1 intrasellar, 2 suprasellar); 114 pituitary adenomas (16 microadenomas, 98 macroadenomas), and 1 case of normal MRI were included. Baseline findings included hormonal changes in 59 patients (48,7%) and visual field changes in 38 patients (31%); in 7 patients (5.8%), clinical presentation was pituitary apoplexy. Complete resection was achieved in 77 patients (63.6%), subtotal resection in 29 (23.9%), and partial resection in 15 (12.3%). In patients with Grade 3 and 4 cavernous sinus invasion, resection was subtotal in 30% (12/39) and complete in 46% (18/39). Hormonal remission was achieved in 16 patients with Cushing disease (84%), 18 patients with prolactinoma (78.2%), and 18 patients with acromegaly (85,7%). There were 12 cases (9%) of cerebrospinal fluid leak, 4 cases of diabetes insipidus, and 3 cases with transient SIADH/hyponatremia. Seven patients developed panhypopituitarism. Postoperative mortality rate was 2.4%. One hundred and three patients (85.3%) were discharged from the hospital less than 48 hours after surgery. CONCLUSION Our results are similar to those reported by renowned pituitary units. Results achieved using an endoscopic approach in pituitary neurosurgery are better than those of microneurosurgery for cavernous sinus invasion.
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Affiliation(s)
- Jorge Torales
- Servicio de Neurocirugía, Hospital Clínic i Provincial de Barcelona, Barcelona, España
| | - Irene Halperin
- Servicio de Endocrinología, Hospital Clínic i Provincial de Barcelona, Barcelona, España
| | - Felicia Hanzu
- Servicio de Endocrinología, Hospital Clínic i Provincial de Barcelona, Barcelona, España
| | - Mireia Mora
- Servicio de Endocrinología, Hospital Clínic i Provincial de Barcelona, Barcelona, España
| | - Isam Alobid
- Servicio de Otorrinolaringología, Hospital Clínic i Provincial de Barcelona, Barcelona, España
| | - Mateo De Notaris
- Servicio de Neurocirugía, Hospital Clínic i Provincial de Barcelona, Barcelona, España
| | - Enrique Ferrer
- Servicio de Neurocirugía, Hospital Clínic i Provincial de Barcelona, Barcelona, España
| | - Joaquim Enseñat
- Servicio de Neurocirugía, Hospital Clínic i Provincial de Barcelona, Barcelona, España.
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