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Caulley L, Quinn JG, Doyle MA, Alkherayf F, Metzendorf MI, Kilty S, Hunink MGM. Surgical and non-surgical interventions for primary and salvage treatment of growth hormone-secreting pituitary adenomas in adults. Cochrane Database Syst Rev 2024; 2:CD013561. [PMID: 38318883 PMCID: PMC10845214 DOI: 10.1002/14651858.cd013561.pub2] [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] [Indexed: 02/07/2024]
Abstract
BACKGROUND Growth hormone (GH)-secreting pituitary adenoma is a severe endocrine disease. Surgery is the currently recommended primary therapy for patients with GH-secreting tumours. However, non-surgical therapy (pharmacological therapy and radiation therapy) may be performed as primary therapy or may improve surgical outcomes. OBJECTIVES To assess the effects of surgical and non-surgical interventions for primary and salvage treatment of GH-secreting pituitary adenomas in adults. SEARCH METHODS We searched CENTRAL, MEDLINE, WHO ICTRP, and ClinicalTrials.gov. The date of the last search of all databases was 1 August 2022. We did not apply any language restrictions. SELECTION CRITERIA Randomised controlled trials (RCTs) and quasi-RCTs of more than 12 weeks' duration, reporting on surgical, pharmacological, radiation, and combination interventions for GH-secreting pituitary adenomas in any healthcare setting. DATA COLLECTION AND ANALYSIS Two review authors independently screened titles and abstracts for relevance, screened for inclusion, completed data extraction, and performed a risk of bias assessment. We assessed studies for overall certainty of the evidence using GRADE. We estimated treatment effects using random-effects meta-analysis. We expressed results as risk ratios (RR) for dichotomous outcomes together with 95% confidence intervals (CI) or mean differences (MD) for continuous outcomes, or in descriptive format when meta-analysis was not possible. MAIN RESULTS We included eight RCTs that evaluated 445 adults with GH-secreting pituitary adenomas. Four studies reported that they included participants with macroadenomas, one study included a small number of participants with microadenomas. The remaining studies did not specify tumour subtypes. Studies evaluated surgical therapy alone, pharmacological therapy alone, or combination surgical and pharmacological therapy. Methodological quality varied, with many studies providing insufficient information to compare treatment strategies or accurately judge the risk of bias. We identified two main comparisons, surgery alone versus pharmacological therapy alone, and surgery alone versus pharmacological therapy and surgery combined. Surgical therapy alone versus pharmacological therapy alone Three studies with a total of 164 randomised participants investigated this comparison. Only one study narratively described hyperglycaemia as a disease-related complication. All three studies reported adverse events, yet only one study reported numbers separately for the intervention arms; none of the 11 participants were observed to develop gallbladder stones or sludge on ultrasonography following surgery, while five of 11 participants experienced any biliary problems following pharmacological therapy (RR 0.09, 95% CI 0.01 to 1.47; 1 study, 22 participants; very low-certainty evidence). Health-related quality of life was reported to improve similarly in both intervention arms during follow-up. Surgery alone compared to pharmacological therapy alone may slightly increase the biochemical remission rate from 12 weeks to one year after intervention, but the evidence is very uncertain; 36/78 participants in the surgery-alone group versus 15/66 in the pharmacological therapy group showed biochemical remission. The need for additional surgery or non-surgical therapy for recurrent or persistent disease was described for single study arms only. Surgical therapy alone versus preoperative pharmacological therapy and surgery Five studies with a total of 281 randomised participants provided data for this comparison. Preoperative pharmacological therapy and surgery may have little to no effect on the disease-related complication of a difficult intubation (requiring postponement of surgery) compared to surgery alone, but the evidence is very uncertain (RR 2.00, 95% CI 0.19 to 21.34; 1 study, 98 participants; very low-certainty evidence). Surgery alone may have little to no effect on (transient and persistent) adverse events when compared to preoperative pharmacological therapy and surgery, but again, the evidence is very uncertain (RR 1.23, 95% CI 0.75 to 2.03; 5 studies, 267 participants; very low-certainty evidence). Concerning biochemical remission, surgery alone compared to preoperative pharmacological therapy and surgery may not increase remission rates up until 16 weeks after surgery; 23 of 134 participants in the surgery-alone group versus 51 of 133 in the preoperative pharmacological therapy and surgery group showed biochemical remission. Furthermore, the very low-certainty evidence did not suggest benefit or detriment of preoperative pharmacological therapy and surgery compared to surgery alone for the outcomes 'requiring additional surgery' (RR 0.48, 95% CI 0.05 to 5.06; 1 study, 61 participants; very low-certainty evidence) or 'non-surgical therapy for recurrent or persistent disease' (RR 1.22, 95% CI 0.65 to 2.28; 2 studies, 100 participants; very low-certainty evidence). None of the included studies measured health-related quality of life. None of the eight included studies measured disease recurrence or socioeconomic effects. While three of the eight studies reported no deaths to have occurred, one study mentioned that overall, two participants had died within five years of the start of the study. AUTHORS' CONCLUSIONS Within the context of GH-secreting pituitary adenomas, patient-relevant outcomes, such as disease-related complications, adverse events and disease recurrence were not, or only sparsely, reported. When reported, we found that surgery may have little or no effect on the outcomes compared to the comparator treatment. The current evidence is limited by the small number of included studies, as well as the unclear risk of bias in most studies. The high uncertainty of evidence significantly limits the applicability of our findings to clinical practice. Detailed reporting on the burden of recurrent disease is an important knowledge gap to be evaluated in future research studies. It is also crucial that future studies in this area are designed to report on outcomes by tumour subtype (that is, macroadenomas versus microadenomas) so that future subgroup analyses can be conducted. More rigorous and larger studies, powered to address these research questions, are required to assess the merits of neoadjuvant pharmacological therapy or first-line pharmacotherapy.
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Affiliation(s)
- Lisa Caulley
- Department of Otolaryngology - Head and Neck Surgery, University of Ottawa, Ottawa, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- Department of Epidemiology, Erasmus University Medical Center Rotterdam, Rotterdam, Netherlands
- Institut for Klinisk Medicin, Aarhus University, Aarhus, Denmark
| | - Jason G Quinn
- Department of Pathology and Laboratory Medicine, Dalhousie University, Halifax, Canada
| | - Mary-Anne Doyle
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- Endocrinology and Metabolism, University of Ottawa, Ottawa, Canada
| | - Fahad Alkherayf
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- Department of Neurosurgery, University of Ottawa, Ottawa, Canada
| | - Maria-Inti Metzendorf
- Institute of General Practice, Medical Faculty of the Heinrich-Heine University, Düsseldorf, Germany
| | - Shaun Kilty
- Department of Otolaryngology - Head and Neck Surgery, University of Ottawa, Ottawa, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - M G Myriam Hunink
- Department of Epidemiology and Biostatistics and Department of Radiology and Nuclear Medicine, Erasmus University Medical Center Rotterdam, Rotterdam, Netherlands
- Center for Health Decision Sciences, Harvard T.H. Chan School of Public Health, Boston, Boston, Massachussetts, USA
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Al-Hadlaq M, Sroussi H. Acromegaly: Overview and associated temporomandibular joint disorders. Oral Dis 2024. [PMID: 38225457 DOI: 10.1111/odi.14861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 11/30/2023] [Accepted: 12/29/2023] [Indexed: 01/17/2024]
Abstract
OBJECTIVE To provide a review on acromegaly and its orofacial manifestations, with a focus on associated arthropathies and temporomandibular joint disorders (TMD). METHODS A review of current literature was performed through an electronic search of three databases: PubMed, ScienceDirect, and Google Scholar. The literature review was focused on the following topics of interest: etiology, diagnosis, and management of acromegaly, orofacial manifestations of acromegaly, acromegalic arthropathies, and acromegaly-associated TMD. RESULTS Acromegaly is a chronic multisystem condition in which excessive production of growth hormone in adults, most commonly caused by benign pituitary adenomas, leads to somatic overgrowth. Orofacial changes are considered hallmarks of the disease. It is important for dentists to recognize signs and symptoms of acromegaly, as this may help to achieve early diagnosis and improve overall disease prognosis. Acromegalic arthropathies typically involve large joints, however, the temporomandibular joints (TMJ) can be affected. TMD associated with acromegaly is under-recognized and poorly characterized in current literature. CONCLUSION In the appropriate clinical context, acromegaly should be considered as part of the differential diagnosis for patients presenting with TMD. Further studies are needed to better characterize the nature of TMD associated with acromegaly and to define the role of TMJ involvement in early diagnosis.
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Affiliation(s)
- Malak Al-Hadlaq
- Department of Oral Medicine, Infection, and Immunity, Harvard School of Dental Medicine, Boston, Massachusetts, USA
- Division of Oral Medicine and Dentistry, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Herve Sroussi
- Department of Oral Medicine, Infection, and Immunity, Harvard School of Dental Medicine, Boston, Massachusetts, USA
- Division of Oral Medicine and Dentistry, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Xiao T, Jiao R, Yang S, Wang Y, Bai X, Zhou J, Li R, Wang L, Yang H, Yao Y, Deng K, Gong F, Pan H, Duan L, Zhu H. Incidence and risk factors of cancers in acromegaly: a Chinese single-center retrospective study. Endocrine 2023; 82:368-378. [PMID: 37442901 PMCID: PMC10543525 DOI: 10.1007/s12020-023-03447-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 07/01/2023] [Indexed: 07/15/2023]
Abstract
PURPOSE To evaluate the incidence of malignancies in acromegaly and to identify risk factors for newly-diagnostic cancers, especially the excessive growth hormone (GH) and insulin-like growth factor-1 (IGF-1). METHODS A retrospective cohort including 1738 consecutive hospitalized patients with acromegaly in a single referral center between 2012 and 2020 (mean follow-up 4.3 years). A gender- and age-matched case-control study (280 patients from the cohort) was performed for risk factor analysis. RESULTS One hundred thirteen malignancies (67 diagnosed after acromegaly) were observed. The overall newly-diagnostic cancer risk of acromegaly was higher than the general population (standardized incidence ratio (SIR) 2.81; 95% CI 2.18-3.57). The risk of thyroid cancer (n = 33, SIR 21.42; 95% CI 13.74-30.08) and colorectal cancer (n = 8, SIR 3.17; 95% CI 1.37-6.25) was elevated. In the overall cohort, IGF-1 (ULN: 1.27 vs. 0.94, p = 0.057), GH (1.30 vs. 1.00 ng/ml, p = 0.12), and disease-controlled rate (34.9% vs. 45.9%, p = 0.203) at the last visit did not reach significance between patients with and without post-diagnostic cancer. In the case-control study, GH (1.80 vs. 0.90 ng/ml, p = 0.018) and IGF-1 (ULN: 1.27 vs. 0.91, p = 0.003) at the last visit were higher in patients with post-diagnostic cancers, with a lower disease-controlled rate. Elder age was a risk factor for cancer. Other metabolic comorbidities and the size of pituitary tumors were similar. CONCLUSION The risk of malignancies, especially thyroid cancer, was increased in patients with acromegaly in our center. More cancer screening should be considered when managing acromegaly, especially in patients with higher posttreatment GH and IGF-1.
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Affiliation(s)
- Tongxin Xiao
- Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Eight-Year Program of Clinical Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Rui Jiao
- Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Eight-Year Program of Clinical Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Shengmin Yang
- Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yi Wang
- Department of Medical Records, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xue Bai
- Department of Medical Records, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jingya Zhou
- Department of Medical Records, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ran Li
- Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Linjie Wang
- Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hongbo Yang
- Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yong Yao
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Kan Deng
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fengying Gong
- Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hui Pan
- Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lian Duan
- Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Huijuan Zhu
- Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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Naik CS, Joshi SS, Mhatre BV, Garad AR, Jain RM. Use of High Condylectomy and Abdominal Dermis Fat Grafting for an Acromegaly Induced Bilateral Condylar Hyperplasia: A Case Report. Cureus 2023; 15:e47039. [PMID: 38022069 PMCID: PMC10643191 DOI: 10.7759/cureus.47039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2023] [Indexed: 12/01/2023] Open
Abstract
Acromegaly is a disorder characterized by hypersecretion of growth hormone, resulting in morbidities associated with multiple systems. Although most of the morbidities are reversed following control of the underlying disease, it may take several weeks to months for the symptoms to subside. One of the most noticeable effects of acromegaly is changes in facial features and jawbone growth, which can lead to severe pain and discomfort. This report describes a case of a 31-year-old patient with acromegaly induced bilateral condylar hyperplasia who presented with severe temporomandibular joint (TMJ), facial pain, and degenerative changes in TMJ. The patient was treated by trans-sphenoidal excision of pituitary adenoma, medications, and radiotherapy, but his hormonal levels were persistently high. Considering the refractory nature of the disease, the patient underwent bilateral high condylectomy, right articular disc removal, and abdominal dermis fat grafting. The surgery arrested the progressive mandibular enlargement and prevented further degenerative changes of TMJ. Although there was some reduction in TMJ pain, the myogenous pain and headache persisted after surgery. TMJ surgery may be selectively used for refractory cases of acromegaly and those requiring discectomy or total joint replacement. This case report describes the role of TMJ surgery in the management of morbidities and symptoms associated with TMJ in acromegaly until biochemical normalcy is achieved.
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Affiliation(s)
- Charudatta S Naik
- Department of Oral and Maxillofacial Surgery, Terna Dental College, Navi Mumbai, IND
| | - Sanjay S Joshi
- Department of Oral and Maxillofacial Surgery, Terna Dental College, Navi Mumbai, IND
| | - Bhupendra V Mhatre
- Department of Oral and Maxillofacial Surgery, Terna Dental College, Navi Mumbai, IND
| | - Aarti R Garad
- Department of Oral and Maxillofacial Surgery, Terna Dental College, Navi Mumbai, IND
| | - Rushika M Jain
- Department of Oral and Maxillofacial Surgery, Terna Dental College, Navi Mumbai, IND
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Peng G, Li X, Zhou Y, Bai J, Hong P, Li W, Zhang Y, Zhang L, Liao Q, Liao M, Zhou L, Sun Z, Shen R, Zheng H, Long M. Clinical Characteristics and Associated Factors of Colonic Polyps in Acromegaly. Exp Clin Endocrinol Diabetes 2022; 130:714-722. [PMID: 36075228 DOI: 10.1055/a-1913-7900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
PURPOSE To investigate the clinical characteristics and associated factors of colonic polyps in patients with acromegaly. METHODS Clinical characteristics and colonoscopy findings of 86 acromegaly patients who received treatment were retrospectively reviewed, and colonoscopy findings and the correlation with growth hormone (GH)-secreting pituitary adenoma (GHPA) volume and hormonal/metabolic levels were analyzed. RESULTS The prevalence of colonic polyps in acromegaly patients was 40.7% and increased significantly with advanced age, especially in those ≥50 years. Multiple polyps (62.8%) and colonic polyps in the left colon (54.2%) were detected more frequently. Compared to acromegaly patients without polyps, those with polyps displayed higher insulin-like growth factor-1 × upper limit of normal (IGF-1×ULN) levels (P=0.03). IGF-1 levels and GHPA volumes in patients with polyps showed increasing trends, although the differences were not significant. GH levels were higher in patients with polyps of diameter ≤5 mm than those with polyps of diameter >5 mm (P=0.031). The univariate and multivariate logistic regression analysis revealed that GHPA volumes (OR: 1.09, 95% CI: 1.01-1.20; P=0.039) and IGF-1×ULN Q2 levels (OR: 6.51, 95% CI: 1.20-44.60; P=0.038) were independent factors for predicting the risk of colonic polyp occurrence in acromegaly patients. A nomogram was prepared to evaluate the risk of colonic polyps in acromegaly patients. CONCLUSION The acromegalic patients are a population with a high prevalence of colonic polyps. GHPA volumes and IGF-1×ULN levels may be predictors of colonic polyp occurrence.
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Affiliation(s)
- Guiliang Peng
- Department of Endocrinology, Translational Research Key Laboratory for Diabetes, The Second Affiliated Hospital (Xinqiao Hospital), Army Medical University, Chongqing, China
| | - Xing Li
- Department of Endocrinology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Yuanyuan Zhou
- Department of Gastroenterology, The Second Affiliated Hospital (Xinqiao Hospital), Army Medical University, Chongqing, China
| | - Jianying Bai
- Department of Gastroenterology, The Second Affiliated Hospital (Xinqiao Hospital), Army Medical University, Chongqing, China
| | - Pian Hong
- Department of Endocrinology, Translational Research Key Laboratory for Diabetes, The Second Affiliated Hospital (Xinqiao Hospital), Army Medical University, Chongqing, China
| | - Weixing Li
- Department of Endocrinology, Translational Research Key Laboratory for Diabetes, The Second Affiliated Hospital (Xinqiao Hospital), Army Medical University, Chongqing, China
| | - Yuling Zhang
- Department of Endocrinology, Translational Research Key Laboratory for Diabetes, The Second Affiliated Hospital (Xinqiao Hospital), Army Medical University, Chongqing, China
| | - Lei Zhang
- Department of Radiology, The Second Affiliated Hospital (Xinqiao Hospital), Army Medical University, Chongqing, China
| | - Qian Liao
- Department of Endocrinology, Translational Research Key Laboratory for Diabetes, The Second Affiliated Hospital (Xinqiao Hospital), Army Medical University, Chongqing, China
| | - Mingyu Liao
- Department of Endocrinology, Translational Research Key Laboratory for Diabetes, The Second Affiliated Hospital (Xinqiao Hospital), Army Medical University, Chongqing, China
| | - Ling Zhou
- Department of Endocrinology, Translational Research Key Laboratory for Diabetes, The Second Affiliated Hospital (Xinqiao Hospital), Army Medical University, Chongqing, China
| | - Zheng Sun
- Department of Medicine, Division of Diabetes, Endocrinology and Metabolism, Baylor College of Medicine, Houston, Texas, USA; Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, Texas, USA
| | - Rufei Shen
- Department of Endocrinology, Translational Research Key Laboratory for Diabetes, The Second Affiliated Hospital (Xinqiao Hospital), Army Medical University, Chongqing, China
| | - Hongting Zheng
- Department of Endocrinology, Translational Research Key Laboratory for Diabetes, The Second Affiliated Hospital (Xinqiao Hospital), Army Medical University, Chongqing, China
| | - Min Long
- Department of Endocrinology, Translational Research Key Laboratory for Diabetes, The Second Affiliated Hospital (Xinqiao Hospital), Army Medical University, Chongqing, China
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Vitali E, Palagano E, Schiavone ML, Mantovani G, Sobacchi C, Mazziotti G, Lania A. Direct effects of octreotide on osteoblast cell proliferation and function. J Endocrinol Invest 2022; 45:1045-1057. [PMID: 35020172 DOI: 10.1007/s40618-022-01740-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 01/03/2022] [Indexed: 12/11/2022]
Abstract
PURPOSE Octreotide (OCT) is a first-generation somatostatin analog (SSA) used in the treatment of acromegaly and neuroendocrine tumors (NETs). In both diseases, OCT interacts with somatostatin receptors 2 and 5 (SSTR2 and SSTR5), inhibiting hormone hypersecretion and cell proliferation. Skeletal health is an important clinical concern in acromegaly and NETs, since acromegalic osteopathy and NET bone metastasis occur in a remarkable number of patients. While OCT's effect on NET and pituitary cells has been extensively investigated, its direct action on bone cells remains unknown. METHODS Here, we investigated OCT direct effects on cell proliferation, differentiation, mineralization, and chemoattractant capacity of murine primary osteoblasts and osteoblast cell line MC3T3-E1. RESULTS OCT inhibited osteoblasts and MC3T3-E1 cell proliferation (- 30 ± 16%, and - 22 ± 4%, both p < 0.05 vs control) and increased MC3T3-E1 cell apoptosis (+ 76 ± 32%, p < 0.05 vs control). The anti-proliferative action of OCT was mediated by SSTR2 and SSTR5 in MC3T3-E1, while its pro-apoptotic effect was abrogated in SSTR2-silenced cells. The analysis of genes related to the early and late phases of osteoblast differentiation showed that OCT did not affect Alp, Runx2, Bglap, Spp1, and Sost levels in MC3T3-E1 cells. Similarly, OCT did not affect ALP activity, mineralization, and osteoclastogenic induction. Finally, Vegfa expression decreased in OCT-treated MC3T3-E1 cells and OCT inhibited pancreatic NET cell migration toward the osteoblast-conditioned medium. CONCLUSION This study provides the first evidence of the direct action of OCT on osteoblasts which may have clinically relevant implications for the management of skeletal health in subjects with acromegaly and metastatic NETs.
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Affiliation(s)
- E Vitali
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, MI, Italy
- Laboratory of Cellular and Molecular Endocrinology, IRCCS Humanitas Research Hospital, Rozzano, MI, Italy
| | - E Palagano
- National Research Council, Institute of Biosciences and BioResources (CNR-IBBR), Via Madonna del Piano-Polo Scientifico CNR 10, 50019, Sesto Fiorentino, FI, Italy
| | - M L Schiavone
- IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, MI, Italy
| | - G Mantovani
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Endocrinology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - C Sobacchi
- IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, MI, Italy
- National Research Council, Institute of Genetic and Biomedical Research (CNR-IRGB), Via Fantoli 16/15, 20138, Milan, Italy
| | - G Mazziotti
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, MI, Italy.
- Endocrinology, Diabetology and Andrology Unit, IRCCS Humanitas Research Hospital, Rozzano, MI, Italy.
| | - A Lania
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, MI, Italy
- Endocrinology, Diabetology and Andrology Unit, IRCCS Humanitas Research Hospital, Rozzano, MI, Italy
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Labadzhyan A, Nachtigall LB, Fleseriu M, Gordon MB, Molitch M, Kennedy L, Samson SL, Greenman Y, Biermasz N, Bolanowski M, Haviv A, Ludlam W, Patou G, Strasburger CJ. Oral octreotide capsules for the treatment of acromegaly: comparison of 2 phase 3 trial results. Pituitary 2021; 24:943-953. [PMID: 34173129 PMCID: PMC8550586 DOI: 10.1007/s11102-021-01163-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/11/2021] [Indexed: 11/17/2022]
Abstract
PURPOSE Results are presented from 2 to 3 trials investigating oral octreotide capsules (OOC) as an alternative to injectable somatostatin receptor ligands (iSRLs) in the treatment of acromegaly. METHODS CH-ACM-01 was an open-label trial (N = 155) and CHIASMA OPTIMAL was a double-blind placebo-controlled (DPC) trial (N = 56), both investigating OOC as maintenance therapy for patients with acromegaly who were biochemical responders receiving iSRLs. RESULTS Baseline characteristics in both trials reflected those expected of patients with acromegaly responding to treatment and were similar between trials, despite differences in inclusion criteria. OOC demonstrated a consistent degree of biochemical response across trials, with 65% of patients in CH-ACM-01 maintaining response during the core period and 64% of patients in CHIASMA OPTIMAL at the end of the DPC. Mean insulin-like growth factor I (IGF-I) levels remained within inclusion criteria at the end of treatment in both trials. Of 110 patients entering the fixed-dose phase in CH-ACM-01, 80% maintained or improved acromegaly symptoms from baseline to the end of treatment. Over 85% of patients in both trials elected to continue into the extension phases. OOC were found to be well tolerated across both trials, and no dose-related adverse events were observed. CONCLUSIONS OOC demonstrated remarkably consistent results for biochemical response, durability of response, and preference to continue with oral treatment across these 2 complementary landmark phase 3 trials, despite differences in the design of each. Trial registration NCT03252353 (August 2017), NCT01412424 (August 2011).
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Affiliation(s)
| | - L B Nachtigall
- MGH Neuroendocrine and Pituitary Center, Chestnut Hill, MA, USA
| | - M Fleseriu
- Pituitary Center, Oregon Health & Sciences University, Portland, OR, USA
| | - M B Gordon
- Allegheny Neuroendocrinology Center, Allegheny General Hospital, Pittsburgh, PA, USA
| | - M Molitch
- Northwestern University, Chicago, IL, USA
| | - L Kennedy
- Cleveland Clinic Foundation, Cleveland, OH, USA
| | | | - Y Greenman
- Sourasky Medical Center and Tel Aviv University, Tel Aviv, Israel
| | - N Biermasz
- Leiden University Medical Center, Leiden, The Netherlands
| | | | - A Haviv
- Chiasma, Inc., Needham, MA, USA
| | - W Ludlam
- Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA
| | - G Patou
- Chiasma, Inc., Needham, MA, USA
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Yilmaz MK, Sulu C, Ozkaya HM, Kadioglu A, Ortac M, Kadioglu P. Evaluation of sex hormone profile and semen parameters in acromegalic male patients. J Endocrinol Invest 2021; 44:2799-2808. [PMID: 34050506 DOI: 10.1007/s40618-021-01593-6] [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: 01/26/2021] [Accepted: 05/13/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To investigate the changes in semen quality and bioavailable testosterone concentrations in acromegalic male patients according to their disease activity and compare them with patients with non-functional pituitary adenoma (NFA) and healthy controls (HC). METHODS Twenty-four acromegalic patients with active disease, 22 acromegalic patients in remission, 10 HCs, and 10 patients with NFA were included. RESULTS Total and calculated bioavailable testosterone concentrations were lower in patients with pituitary disease. Patients with acromegaly had more severely impaired total testosterone levels and semen parameters in comparison to HCs and patients with NFA. The degree of impairment was more prominent in acromegalic patients with active disease than acromegalic patients in remission. Acromegalic patients in remission had residual impairments in both semen quality and testosterone concentrations. Patients with NFA had the lowest concentrations of calculated bioavailable testosterone, followed by acromegalic patients with active disease and acromegalic patients in remission. Increasing growth hormone (GH) levels were found to be associated with both more severely impaired semen quality and androgen concentrations. CONCLUSION Growth hormone hypersecretion can disturb reproductive biology and thereof semen quality. The reduction in semen quality and androgen levels may not fully recover upon disease control. Clinicians should be aware of the increased risk of impaired semen parameters and reduced total/bioavailable levels in acromegalic patients, especially in the setting of active disease.
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Affiliation(s)
- M K Yilmaz
- Department of Internal Medicine, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - C Sulu
- Division of Endocrinology, Metabolism and Diabetes, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - H M Ozkaya
- Division of Endocrinology, Metabolism and Diabetes, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - A Kadioglu
- Department of Urology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - M Ortac
- Department of Urology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - P Kadioglu
- Division of Endocrinology, Metabolism and Diabetes, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey.
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9
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Neggers S, Badiu C, Biagetti B, Durand-Gasselin L, Petit A, Petrossians P, Regnault B, Rich D, Shafigullina Z, Shustov S, Vydrych A. Pharmacological and safety profile of a prolonged-release lanreotide formulation in acromegaly. Expert Rev Clin Pharmacol 2021; 14:1551-1560. [PMID: 34664531 DOI: 10.1080/17512433.2021.1986004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Patients with acromegaly require lifelong medication; a longer dosing interval would reduce treatment burden. This study investigated the pharmacokinetics, pharmacodynamics and safety profile of a new prolonged-release formulation (PRF) of lanreotide every 12 weeks. RESEARCH DESIGN AND METHODS In this multicenter, open-label, dose-ascending study, cohorts of nine patients with acromegaly received single doses of lanreotide PRF according to a 3 + 3 + 3 scheme in order to determine the maximum tolerated dose (MTD). Following a 12-week treatment period, patients were followed up for a further 12 weeks. Serum lanreotide, insulin-like growth factor-1 and growth hormone concentrations were analyzed. Adverse events were monitored throughout the study. RESULTS The MTD was not reached. Peak lanreotide serum concentration values were similar in all cohorts, whereas area under the curve values from time zero to 85 days increased but were not dose-proportional. The apparent elimination half-life of lanreotide PRF was approximately 54-63 days, in line with the expected prolonged-release characteristics. Growth hormone and insulin-like growth factor-1 levels were generally stable. CONCLUSIONS The safety and tolerability profile was in-line with the known safety profile of lanreotide autogel. Lanreotide PRF was well tolerated and the pharmacokinetic profile suggests that a dosing interval of 12 weeks could be achievable. CLINICAL TRIAL REGISTRATION www.clinicaltrials.gov identifier is NCT02396953; EudraCT 2014-002389-62.
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Affiliation(s)
- Sebastian Neggers
- Medicine and Endocrinology, Erasmus University Medical Center, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Corin Badiu
- Department of Endocrinology National Institute of Endocrinology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Betina Biagetti
- Department of Endocrinology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | | | - Anne Petit
- Drug Product Development & Industrialization, Ipsen PharmSciences, Dreux, France
| | - Patrick Petrossians
- Department of Endocrinology, University Hospital of Liège, Sart Tilman Campus, Liège, Belgium
| | | | - David Rich
- Global Development, Rare Diseases, Ipsen BioInnovation, Abingdon, UK
| | - Zulfiya Shafigullina
- Department of Endocrinology, North-Western State Medical University Named after I.I Mechnikov, St. Petersburg, Russia
| | - Sergey Shustov
- Department of Endocrinology, North-Western State Medical University Named after I.I Mechnikov, St. Petersburg, Russia
| | - Anna Vydrych
- Department of Endocrinology, North-Western State Medical University Named after I.I Mechnikov, St. Petersburg, Russia
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10
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Cambria V, Beccuti G, Prencipe N, Penner F, Gasco V, Gatti F, Romanisio M, Caputo M, Ghigo E, Zenga F, Grottoli S. First but not second postoperative day growth hormone assessments as early predictive tests for long-term acromegaly persistence. J Endocrinol Invest 2021; 44:2427-2433. [PMID: 33837920 PMCID: PMC8502138 DOI: 10.1007/s40618-021-01553-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 03/10/2021] [Indexed: 10/24/2022]
Abstract
PURPOSE Postoperative assessment of acromegaly activity is typically performed at least 3 months after neurosurgery (NS). Few studies have evaluated the use of early postoperative growth hormone (GH) levels as a test to predict short- and long-term remission of acromegaly. Our objective was to evaluate the diagnostic performance of serum random GH on a postoperative day one (D1-rGH) and two (D2-rGH), particularly in predicting long-term disease persistence. MATERIALS AND METHODS Forty-one subjects with acromegaly who were undergoing NS were enrolled (mean age ± SD 47.4 ± 13.1 years at diagnosis; women 54%; macroadenomas 71%). The final assessment of disease activity was performed one year after NS. ROC curves were used to evaluate the diagnostic performance of D1-rGH and D2-rGH. RESULTS After a 1-year follow-up, the overall remission rate was 55%. ROC analysis identified an optimal D1-rGH cut-off value of 2.1 ng/mL for diagnosing long-term disease persistence (55.6% SE; 90.9% SP). The cut-off point became 2.5 ng/mL after maximizing specificity for disease persistence (yielding a 100% positive predictive value) and 0.3 ng/mL after maximizing sensitivity for disease remission. The optimal D2-rGH cut-off value was 0.6 ng/mL (81.8% SE; 50% SP); the cut-off point became 2.9 ng/mL after maximizing specificity and 0.1 ng/mL after maximizing sensitivity, with no clinical utility. CONCLUSIONS D1-rGH could be a highly specific test for the early diagnosis of long-term acromegaly persistence, which is predicted by a value > 2.5 ng/mL with a great degree of certainty. The diagnostic performance of D2-rGH was insufficient. Further research is required to validate these preliminary results prior to modifying the postoperative management of acromegaly.
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Affiliation(s)
- V. Cambria
- Division of Endocrinology, Diabetes and Metabolism, Department of Medical Sciences, University of Turin, Corso Dogliotti 14, 10126 Turin, Italy
| | - G. Beccuti
- Division of Endocrinology, Diabetes and Metabolism, Department of Medical Sciences, University of Turin, Corso Dogliotti 14, 10126 Turin, Italy
| | - N. Prencipe
- Division of Endocrinology, Diabetes and Metabolism, Department of Medical Sciences, University of Turin, Corso Dogliotti 14, 10126 Turin, Italy
| | - F. Penner
- Division of Neurosurgery, Department of Neurosciences “Rita Levi Montalcini”, University of Turin, Turin, Italy
| | - V. Gasco
- Division of Endocrinology, Diabetes and Metabolism, Department of Medical Sciences, University of Turin, Corso Dogliotti 14, 10126 Turin, Italy
| | - F. Gatti
- Division of Endocrinology, Diabetes and Metabolism, Department of Medical Sciences, University of Turin, Corso Dogliotti 14, 10126 Turin, Italy
| | - M. Romanisio
- Division of Endocrinology, Diabetes and Metabolism, Department of Medical Sciences, University of Turin, Corso Dogliotti 14, 10126 Turin, Italy
| | - M. Caputo
- Division of Endocrinology, Department of Translational Medicine, University of Eastern Piedmont “Amedeo Avogadro”, Novara, Italy
| | - E. Ghigo
- Division of Endocrinology, Diabetes and Metabolism, Department of Medical Sciences, University of Turin, Corso Dogliotti 14, 10126 Turin, Italy
| | - F. Zenga
- Division of Endocrinology, Department of Translational Medicine, University of Eastern Piedmont “Amedeo Avogadro”, Novara, Italy
| | - S. Grottoli
- Division of Endocrinology, Diabetes and Metabolism, Department of Medical Sciences, University of Turin, Corso Dogliotti 14, 10126 Turin, Italy
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11
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Pollock NI, Cohen LE. Growth Hormone Deficiency and Treatment in Childhood Cancer Survivors. Front Endocrinol (Lausanne) 2021; 12:745932. [PMID: 34745010 PMCID: PMC8569790 DOI: 10.3389/fendo.2021.745932] [Citation(s) in RCA: 4] [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] [Received: 07/30/2021] [Accepted: 09/27/2021] [Indexed: 01/21/2023] Open
Abstract
Growth hormone (GH) deficiency is a common pituitary hormone deficiency in childhood cancer survivors (CCS). The identification, diagnosis, and treatment of those individuals at risk are important in order to minimize associated morbidities that can be ameliorated by treatment with recombinant human GH therapy. However, GH and insulin-like growth factor-I have been implicated in tumorigenesis, so there has been concern over the use of GH therapy in patients with a history of malignancy. Reassuringly, GH therapy has not been shown to increase risk of tumor recurrence. These patients have an increased risk for development of meningiomas, but this may be related to their history of cranial irradiation rather than to GH therapy. In this review, we detail the CCS who are at risk for GHD and the existing evidence on the safety profile of GH therapy in this patient population.
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Affiliation(s)
- Netanya I. Pollock
- Division of Endocrinology, Department of Pediatrics, Boston Children’s Hospital and Harvard Medical School, Boston, MA, United States
| | - Laurie E. Cohen
- Division of Endocrinology, Department of Pediatrics, Boston Children’s Hospital and Harvard Medical School, Boston, MA, United States
- Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, Boston, MA, United States
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12
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Celik D, Duyar SS, Aksu F, Firat S, Ciftci B. Evaluation of Acromegaly patients with sleep disturbance related symptoms. Pak J Med Sci 2021; 37:1161-1165. [PMID: 34290801 PMCID: PMC8281146 DOI: 10.12669/pjms.37.4.4229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 03/24/2021] [Accepted: 04/02/2021] [Indexed: 11/30/2022] Open
Abstract
Background and Objectives: It is known that the prevalence of obstructive sleep apnea (OSA) is increased in acromegaly. Craniofacial anomalies, macroglossia, and thickening of the laryngeal wall caused by the increase in soft tissue in these patients lead to OSA. Also, the increase in growth hormone can trigger central apnea by causing a decrease in respiratory drive. Determining the polysomnographic characteristics of acromegaly patients is important to reveal the effect of these mechanisms. Methods: The demographic and polysomnographic characteristics of 33 acromegaly patients who underwent polysomnography (PSG) with suspicion of sleep disorders between 2011 and 2018 in the sleep laboratory of our hospital were retrospectively analyzed. One of the patients was excluded from the analysis because PSG was performed in the postoperative period. The remaining 32 patients with active acromegaly were grouped according to their gender and the presence of OSA and compared with statistical methods in terms of polysomnographic and clinical features. Results: OSA (AHI>5) was detected in 78.1% of 32 active acromegaly patients (18 females, 14 males) who underwent PSG with suspicion of sleep-disordered breathing. Moderate-severe OSA (62.5%) was found in most patients, and there was no difference between the sexes in terms of OSA detection rate and OSA severity. Respiratory events appear to be predominantly obstructive hypopneas. Also, the polysomnographic features of female and male acromegaly patients with OSA were found to be similar. It is seen that the OSA group is similar to the group with simple snoring in terms of body mass index (BMI), but is statistically significantly older (p=0,007). A positive correlation was found between age and AHI in pairwise correlation analysis (r:0,426 p:0,015, respectively). Conclusion: Considering that the prevalence of OSA in the population is approximately 5%, our results show that the risk of OSA in acromegaly increases, and obstructive pathways are effective in this increase. The probability of OSA occurrence and polysomnographic features between the genders are similar. Although the median BMI of the patients with and without OSA was similar, the median age was higher in the group with OSA, middle-aged acromegaly patients should be evaluated in terms of OSA even if there is no obvious obesity.
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Affiliation(s)
- Deniz Celik
- Dr. Deniz Celik, Health Sciences University Atatürk Chest Diseases and Thoracic Surgery Education and Research Hospital, Department of Chest Diseases, Ankara Turkey
| | - Sezgi Sahin Duyar
- Dr. Sezgi Sahin Duyar, Health Sciences University Ataturk Chest Diseases and Thoracic Surgery Education and Research Hospital, Sleep Disorders Center, Ankara Turkey
| | - Funda Aksu
- Dr. Funda Aksu, Health Sciences University Ataturk Chest Diseases and Thoracic Surgery Education and Research Hospital, Sleep Disorders Center, Ankara Turkey
| | - Selma Firat
- Prof. Dr. Selma Firat, Health Sciences University Ataturk Chest Diseases and Thoracic Surgery Education and Research Hospital, Sleep Disorders Center, Ankara Turkey
| | - Bulent Ciftci
- Prof. Dr. Bulent Ciftci, Yozgat Bozok University, Medical School, Department of Chest Diseases, Yozgat Turkey
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13
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Parolin M, Dassie F, Vettor R, Steeds RP, Maffei P. Electrophysiological features in acromegaly: re-thinking the arrhythmic risk? J Endocrinol Invest 2021; 44:209-221. [PMID: 32632903 DOI: 10.1007/s40618-020-01343-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 06/22/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Acromegaly is disease associated with a specific cardiomyopathy. Hitherto, it has been widely understood that acromegaly carries an increased risk of arrhythmia. PURPOSE In this review we show that evidences are limited to a small number of case-control studies that reported increased rates of premature ventricular beats (PVB) but no more significant arrhythmia. In contrast, there are several studies that have reported impaired preclinical markers of arrhythmia, including reduced heart rate variability, increased late potentials, QT interval dispersion, impaired heart rate recovery after physical exercise and left ventricular dysynchrony. Whilst these markers are associated with an adverse cardiovascular prognosis in the general population, they do not have a high independent positive predictive accuracy for arrhythmia. In acromegaly, case reports have described sudden cardiac death, ventricular tachyarrhythmia and advanced atrio-ventricular block that required implantation of a cardio-defibrillator or permanent pacemaker. Treatment with somatostatin analogues can reduce cardiac dysrhythmia in some cases by reducing heart rate, PVBs and QT interval. Pegvisomant reduces mean heart rate. Pasireotide is associated with QT prolongation. In the absence of good quality data on risk of arrhythmia in acromegaly, the majority of position statements and guidelines suggest routine 12-lead electrocardiography (ECG) and transthoracic echocardiography (TTE) in every patient at diagnosis and then follow up dependent on initial findings.
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Affiliation(s)
- M Parolin
- Department of Medicine (DIMED), University of Padua, Clinica Medica 3, via Giustiniani 2, 35128, Padova, Italy.
| | - F Dassie
- Department of Medicine (DIMED), University of Padua, Clinica Medica 3, via Giustiniani 2, 35128, Padova, Italy
| | - R Vettor
- Department of Medicine (DIMED), University of Padua, Clinica Medica 3, via Giustiniani 2, 35128, Padova, Italy
| | - R P Steeds
- University Hospital Birmingham and University of Birmingham, Cardiology, Birmingham, West Midlands, UK
| | - P Maffei
- Department of Medicine (DIMED), University of Padua, Clinica Medica 3, via Giustiniani 2, 35128, Padova, Italy
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14
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Facial Pain and Temporomandibular Joint Dysfunction Secondary to Acromegaly: Treatment with Manual Therapy, Neuromuscular Re-education - A Case Report. REHABILITATION ONCOLOGY 2021; 38:127-133. [PMID: 33447472 DOI: 10.1097/01.reo.0000000000000190] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Background and Purpose Acromegaly is a disorder typically caused by a benign pituitary adenoma resulting in hypersecretion of growth hormone. Common sequelae, including musculoskeletal changes and arthropathies can result in facial pain and temporomandibular disorder (TMD) that persist beyond primary treatment. Due to the unique etiology of facial pain and TMD in cases of acromegaly, the generalizability of established physical therapy (PT) literature for treatment of TMD cannot be assumed. The purpose of this case report was to illustrate an example of multimodal PT as a treatment strategy for facial pain and TMD secondary to acromegaly following treatment for benign pituitary macroadenoma. Case Description 48-year-old male patient with history significant for benign pituitary macroadenoma, presented with facial pain and TMD secondary to acromegaly. Patient-reported outcomes of pain, function, and quality of life were assessed utilizing the Gothenburg Trismus Questionnaire (GTQ) at baseline, eighth PT visit, and eight weeks following course of PT. Quantity and quality of jaw mobility were assessed at baseline and post-intervention using standard goniometric measurements and observation. A total of nine PT sessions were delivered over three months consisting of manual therapy, relaxation techniques, neuromuscular re-education, and therapeutic exercise. Outcomes After eight PT visits, patient's GTQ score improved from 81% to 67.6%, with a corresponding decrease in pain and improved symmetry of jaw mobility. Eight weeks following last PT visit, patient's GTQ score further decreased from 67.6% to 61.3%. Discussion Conservative management through multimodal PT may be effective in managing facial pain and TMD secondary to acromegaly following treatment for benign pituitary macroadenoma.
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15
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Puig-Domingo M, Bernabéu I, Picó A, Biagetti B, Gil J, Alvarez-Escolá C, Jordà M, Marques-Pamies M, Soldevila B, Gálvez MA, Cámara R, Aller J, Lamas C, Marazuela M. Pasireotide in the Personalized Treatment of Acromegaly. Front Endocrinol (Lausanne) 2021; 12:648411. [PMID: 33796079 PMCID: PMC8008639 DOI: 10.3389/fendo.2021.648411] [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: 12/31/2020] [Accepted: 02/22/2021] [Indexed: 12/25/2022] Open
Abstract
The delay in controlling the disease in patients who do not respond to first-line treatment with first generation somatostatin receptor ligands (first-generation SRLs) can be quantified in years, as every modification in the medical therapy requires some months to be fully evaluated. Considering this, acromegaly treatment should benefit from personalized medicine therapeutic approach by using biomarkers identifying drug response. Pasireotide has been positioned mostly as a compound to be used in first-generation SRLs resistant patients and after surgical failure, but sufficient data are now available to indicate it is a first line therapy for patients with certain characteristics. Pasireotide has been proved to be useful in patients in which hyperintensity T2 MRI signal is shown and in those depicting low SST2 and high expression of SST5, low or mutated AIP condition and sparsely granulated immunohistochemical pattern. This combination of clinical and pathological characteristics is unique for certain patients and seems to cluster in the same cases, strongly suggesting an etiopathogenic link. Thus, in this paper we propose to include this clinico-pathologic phenotype in the therapeutic algorithm, which would allow us to use as first line medical treatment those compounds with the highest potential for achieving the fastest control of GH hypersecretion as well as a positive effect upon tumor shrinkage, therefore accelerating the implementation of precision medicine for acromegaly. Moreover, we suggest the development, validation and clinical use of a pasireotide acute test, able to identify patients responsive to pasireotide LAR as the acute octreotide test is able to do for SRLs.
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Affiliation(s)
- Manel Puig-Domingo
- Endocrinology & Nutrition Service, Germans Trias Hospital and Research Institute, Badalona, Autonomous University of Barcelona, Badalona, Spain
- *Correspondence: Manel Puig-Domingo,
| | - Ignacio Bernabéu
- Endocrinology & Nutrition Service, Complejo Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Antonio Picó
- Endocrinology & Nutrition Service, University Hospital, Alicante, Spain
| | - Betina Biagetti
- Endocrinology & Nutrition Service, Vall d’Hebron University Hospital, Barcelona, Spain
| | - Joan Gil
- Endocrinology & Nutrition Service, Germans Trias Hospital and Research Institute, Badalona, Autonomous University of Barcelona, Badalona, Spain
| | | | - Mireia Jordà
- Endocrinology & Nutrition Service, Germans Trias Hospital and Research Institute, Badalona, Autonomous University of Barcelona, Badalona, Spain
| | - Montserrat Marques-Pamies
- Endocrinology & Nutrition Service, Germans Trias Hospital and Research Institute, Badalona, Autonomous University of Barcelona, Badalona, Spain
| | - Berta Soldevila
- Endocrinology & Nutrition Service, Germans Trias Hospital and Research Institute, Badalona, Autonomous University of Barcelona, Badalona, Spain
| | - María-Angeles Gálvez
- Endocrinology & Nutrition Service, Reina Sofia University Hospital, Córdoba, Spain
| | - Rosa Cámara
- Endocrinology & Nutrition Service, La Fe University Hospital, Valencia, Spain
| | - Javier Aller
- Endocrinology & Nutrition Service, Puerta de Hierro University Hospital, Majadahonda, Spain
| | - Cristina Lamas
- Endocrinology & Nutrition Service, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - Mónica Marazuela
- Endocrinology & Nutrition Service, La Princesa University Hospital, Madrid, Spain
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Ribeiro-Oliveira A, Brook RA, Munoz KA, Beren IA, Whalen JD, Kleinman NL, Yuen KCJ. Burden of acromegaly in the United States: increased health services utilization, location of care, and costs of care. J Med Econ 2021; 24:432-439. [PMID: 33663311 DOI: 10.1080/13696998.2021.1898968] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Limited information is available on the utilization and healthcare costs among patients with acromegaly. The purpose of this study was to assess the impact of acromegaly on healthcare utilization and costs by locations of care (LoC). METHODS Patients with acromegaly and controls were identified from an analysis of drug and medical claims filed from January 2010 to April 2019 from a US employer database. Each patient with acromegaly was matched with 20 random controls (without acromegaly) selected from the database. Claims were tracked for 12 months postdiagnosis (or matched date for controls). Outcomes by LoC, including costs, services, and likelihood of use, were compared using two-stage regression models or logistic regression models, controlling for demographic and job-related variables, and Charlson comorbidity index scores. RESULTS Claims from 60 patients with acromegaly and 1,200 controls were analyzed. Compared with the control group, patients with acromegaly had significantly higher likelihoods of receiving care in a physician's office [odds ratio > 1,000], inpatient [OR = 8.010], outpatient [OR = 12.656], laboratory [OR = 3.681], and 'other' locations [OR = 4.033] (all p < .001), except in an emergency department (ED). Significantly more services were performed at each LoC for those with acromegaly (p < .01) but not in an ED. Total costs were more than 5-fold higher for the acromegaly cohort compared with controls (p < .05). Costs by LoC were consistently higher (p < .001) for patients with acromegaly vs. controls, with mean annual cost differences greatest in outpatient hospital/clinic ($9,611 vs $1,355), inpatient ($8,646 vs $739), physicians' office ($4,762 vs $1,301), other ($2,001 vs $367), and laboratory ($508 vs $66). ED-related treatment costs were not significantly different between cohorts. CONCLUSIONS Compared with matched controls, patients with acromegaly were more likely to utilize healthcare services in nearly all LoCs and accrue higher expenditures at each LoC, with the exception of ED services.
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Hung NM, He DV, Kien VD. Reappraisal of microscopic microsurgical transsphenoidal surgery for GH-secreting pituitary macroadenoma in patients with acromegaly: Historical data from Vietnam (2010–2013). INTERDISCIPLINARY NEUROSURGERY 2020. [DOI: 10.1016/j.inat.2020.100811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Abstract
Acromegaly is a systemic disease associated with increased morbidity and mortality. Most of these comorbidities can be prevented or delayed with adequate disease treatment. Although three modalities of treatment (surgery, medical treatment, and radiotherapy) are available and new drugs were approved in the last decades, there are still some patients that maintain disease activity despite treatment. Therefore, there is a need for novel therapies for acromegaly and for that purpose new formulations of currently used drugs and also new drugs are currently under study. In this review, we summarize the novel therapies for acromegaly.
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Affiliation(s)
- Bernardo Maia
- Neuroendocrinology Research Center/Endocrinology Division – Medical School and Hospital Universitário Clementino Fraga Filho – Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Leandro Kasuki
- Neuroendocrinology Research Center/Endocrinology Division – Medical School and Hospital Universitário Clementino Fraga Filho – Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
- Neuroendocrinology Division – Instituto Estadual do Cérebro Paulo Niemeyer, Rio de Janeiro, Brazil
- Endocrinology Division – Hospital Federal de Bonsucesso, Rio de Janeiro Brazil
| | - Mônica R Gadelha
- Neuroendocrinology Research Center/Endocrinology Division – Medical School and Hospital Universitário Clementino Fraga Filho – Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
- Neuroendocrinology Division – Instituto Estadual do Cérebro Paulo Niemeyer, Rio de Janeiro, Brazil
- Neuropatology and Molecular Genetics Laboratory – Instituto Estadual do Cérebro Paulo Niemeyer, Rio de Janeiro, Brazil
- Correspondence should be addressed to M R Gadelha:
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Kaffaf MB, Şeşen P, Şakar O. Rehabilitation of Occlusal Vertical Dimension in a Patient with Acromegaly: A Clinical Report. J Prosthodont 2020; 30:97-103. [PMID: 33150642 DOI: 10.1111/jopr.13280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2020] [Indexed: 11/28/2022] Open
Abstract
Acromegaly is a rare acquired disorder caused by excessive growth hormone production. Dentists play an important role in the diagnosis of this disorder because of intraoral and extraoral symptoms such as extreme growth of the mandible, enlargement of the maxilla, diastema between teeth, a tendency toward malocclusion, a wide and thick nose, a marked malar bone, and thick lips. The prosthetic treatment of these patients is challenging because growth in the condyles and rami can lead to the development of a severe class III jaw relationship. This case report describes the prosthetic treatment of a patient with acromegaly. A decreased occlusal vertical dimension and class III jaw relationship were determined by intraoral and extraoral examinations and cephalometric radiography. The occlusal vertical dimension was reestablished by increasing it approximately 10 mm, as per the esthetic and functional needs of the patient. Four years after treatment, the patient was functioning well, and neither occlusal disharmony nor temporomandibular disorder was observed.
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Affiliation(s)
- Mehmet Berk Kaffaf
- Department of Prosthodontics, Istanbul University, Faculty of Dentistry, Istanbul, Turkey
| | - Pınar Şeşen
- Department of Prosthodontics, Istanbul University, Faculty of Dentistry, Istanbul, Turkey
| | - Olcay Şakar
- Department of Prosthodontics, Istanbul University, Faculty of Dentistry, Istanbul, Turkey
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Taylor DG, Janssen A, Ding D, Xu Z, Mehta GU, Liscak R, Kano H, Kosak M, Martinez-Moreno N, Hobbs L, Chen CJ, Grills IS, Mathieu D, Lunsford LD, Vance ML, Sheehan JP. Whole Sella vs Targeted Stereotactic Radiosurgery for Acromegaly: A Multicenter Matched Cohort Study. Neurosurgery 2020; 86:656-664. [PMID: 31384920 DOI: 10.1093/neuros/nyz245] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 04/11/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Targeted stereotactic radiosurgery (SRS) with sparing of the residual pituitary is the traditional radiosurgical method for pituitary adenomas. Whole-sella SRS is an alternative choice for radiologically indeterminate or large adenomas, the safety and efficacy of which has yet to be determined. OBJECTIVE To determine if whole-sella SRS in acromegaly would have comparable radiographic and biochemical control to targeted SRS. We performed a multicenter, retrospective matched cohort study to compare outcomes between groups. METHODS We conducted a retrospective review of acromegalic patients who underwent SRS from 1990 to 2016 at 10 centers participating in the International Radiosurgery Research Foundation. Whole-sella and targeted SRS patients were then matched in a 1:1 ratio. RESULTS A total of 128 patients were eligible for inclusion. Whole-sella patients had a higher pre-SRS random serum growth hormone, larger treatment volume, and higher maximum point dose to the optic apparatus. The rates of initial/durable endocrine remission, new loss of pituitary function, and new cranial neuropathy were similar between groups. Mortality and new visual deficit were higher in the whole-sella cohort, though not statistically significant. CONCLUSION There was no difference in biochemical remission or recurrence between treatment groups. Although not statistically significant, the higher rates of tumor regression and lower rates of mortality and new visual deficit may suggest consideration of targeted SRS over whole-sella SRS in acromegaly treatment. Further research is needed to determine the association between visual deficits and mortality with whole-sella SRS.
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Affiliation(s)
- Davis G Taylor
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
| | - Andrew Janssen
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
| | - Dale Ding
- Department of Neurosurgery, University of Louisville, Louisville, Kentucky
| | - Zhiyuan Xu
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
| | - Gautam U Mehta
- Department of Neurosurgery, MD Anderson Cancer Center, Houston, Texas
| | - Roman Liscak
- Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
| | - Hideyuki Kano
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Mikulas Kosak
- First Faculty of Medicine, 3rd Department of Medicine, Charles University, Prague, Czech Republic
| | | | - Landon Hobbs
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
| | - Ching-Jen Chen
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
| | - Inga S Grills
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, Michigan
| | - David Mathieu
- Centre de recherche du CHUS, Division of Neurosurgery, University of Sherbrooke, Sherbrooke, Canada
| | - L Dade Lunsford
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Mary Lee Vance
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia.,Department of Medicine, University of Virginia, Charlottesville, Virginia
| | - Jason P Sheehan
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
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Amodru V, Petrossians P, Colao A, Delemer B, Maione L, Neggers SJCMM, Decoudier B, Kamenicky P, Castinetti F, Hana V, Pivonello R, Carvalho D, Brue T, Beckers A, Chanson P, Cuny T. Discordant biological parameters of remission in acromegaly do not increase the risk of hypertension or diabetes: a study with the Liege Acromegaly Survey database. Endocrine 2020; 70:134-142. [PMID: 32562181 DOI: 10.1007/s12020-020-02387-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 06/08/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE Acromegaly is a rare disease due to growth hormone (GH)-secreting pituitary adenoma. GH and IGF-1 levels are usually congruent, indicating either remission or active disease; however, a discrepancy between GH and IGF-1 may occur. We aimed to evaluate the outcome of diabetes mellitus (DM) and hypertension (HT) in acromegalic patients with congruent GH and/or IGF-1 levels vs. discordant biochemical parameters. METHODS Retrospective analysis of the data of 3173 patients from the Liege Acromegaly Survey (LAS) allowed us to include 190 patients from 8 tertiary referral centers across Europe, treated by surgery, with available data concerning DM and HT both at diagnosis and at the last follow-up (LFU). We recorded the number of anti-HT and anti-DM drugs used at the first evaluation and at LFU for every patient. RESULTS Ninety-nine patients belonged to the REM group (concordant parameters), 65 patients were considered as GHdis (high random GH/controlled IGF-1), and 26 patients were considered as IGF-1dis (high IGF-1/controlled random GH). At diagnosis, 72 patients (37.8%) had HT and 54 patients had DM (28.4%). There was no statistically significant difference in terms of the number of anti-HT and anti-DM drugs at diagnosis versus LFU (mean duration: 7.3 ± 4.5 years) between all three groups. CONCLUSION The long-term outcome of DM and HT in acromegaly does not tend to be more severe in patients with biochemical discordance in comparison with patients considered as in remission on the basis of concordant biological parameters, suggesting that patients with biochemical discordance do not require a closer follow-up.
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Affiliation(s)
- V Amodru
- Aix Marseille Univ, APHM, INSERM, MMG, Service d'endocrinologie, Hôpital de la Conception, Marseille, France
| | - P Petrossians
- Department of Endocrinology, CHU de Liège, Université de Liege, Liège, Belgium
| | - A Colao
- Dipartimento Di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, University "Federico II", Naples, Italy
| | - B Delemer
- Service d'endocrinologie, CHU de Reims, Reims, France
| | - L Maione
- Service d'Endocrinologie et des Maladies de la Reproduction, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France
| | - S J C M M Neggers
- Section of Endocrinology Department of Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - B Decoudier
- Service d'endocrinologie, CHU de Reims, Reims, France
| | - P Kamenicky
- Service d'Endocrinologie et des Maladies de la Reproduction, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France
| | - F Castinetti
- Aix Marseille Univ, APHM, INSERM, MMG, Service d'endocrinologie, Hôpital de la Conception, Marseille, France
| | - V Hana
- Third Department of Internal Medicine, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - R Pivonello
- Dipartimento Di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, University "Federico II", Naples, Italy
| | - D Carvalho
- Department of Endocrinology Diabetes and Metabolism, Centro Hospitalar Universitário S. João, Faculty of Medicine, Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
| | - T Brue
- Aix Marseille Univ, APHM, INSERM, MMG, Service d'endocrinologie, Hôpital de la Conception, Marseille, France
| | - A Beckers
- Department of Endocrinology, CHU de Liège, Université de Liege, Liège, Belgium
| | - P Chanson
- Service d'Endocrinologie et des Maladies de la Reproduction, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France
| | - T Cuny
- Aix Marseille Univ, APHM, INSERM, MMG, Service d'endocrinologie, Hôpital de la Conception, Marseille, France.
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YILMAZ N, TAZEGÜL G, SARI R, ALTUNBAŞ H, BALCI M. Akromegali hastalarında benign ve malign tümör sıklığı. PAMUKKALE MEDICAL JOURNAL 2020. [DOI: 10.31362/patd.656681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/03/2024]
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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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An Z, Lei T, Duan L, Hu P, Gou Z, Zhang L, Durand-Gasselin L, Wang N, Wang Y, Gu F. Efficacy and safety of lanreotide autogel compared with lanreotide 40 mg prolonged release in Chinese patients with active acromegaly: results from a phase 3, prospective, randomized, and open-label study (LANTERN). BMC Endocr Disord 2020; 20:57. [PMID: 32366244 PMCID: PMC7199333 DOI: 10.1186/s12902-020-0524-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 03/23/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Lanreotide autogel is a somatostatin analog (SSA) approved for the treatment of acromegaly in 73 countries worldwide; however, it is not yet approved in China. The aim of this study was to evaluate the efficacy and safety of lanreotide autogel compared with lanreotide 40 mg prolonged release (PR) in Chinese patients with active acromegaly. METHODS LANTERN was a phase 3, randomized, open-label, non-inferiority study. Patients with active acromegaly who had undergone surgery ≥3 months prior, or were unlikely or unable to undergo surgery, were treated with lanreotide autogel 60/90/120 mg (monthly deep subcutaneous injection) or lanreotide 40 mg PR (intramuscular injection every 7, 10, or 14 days) for 32 weeks. Primary endpoint was mean change-from-baseline in age-adjusted insulin-like growth factor-1 (IGF-1) standard deviation scores (SDS) at the end-of-study. Secondary endpoints included: growth hormone (GH) levels ≤2.5 μg/L or ≤ 1.0 μg/L, ≥20% reduction in tumor volume (TV) and safety. RESULTS In total, 128 patients were randomized and received study treatment. Lanreotide autogel was non-inferior to lanreotide 40 mg PR: treatment difference (95% CI) for IGF-1 SDS between groups was - 0.32 (- 0.74, 0.11; per protocol population) and - 0.27 (- 0.63, 0.09; intention-to-treat [ITT] population), respectively. Reductions in IGF-1 (- 6.453 vs - 7.003) and GH levels (- 9.548 μg/L vs - 13.182 μg/L), and the proportion of patients with ≥1 acromegaly symptom (- 20.3% vs - 32.5%) were observed from baseline to end-of-study in lanreotide autogel and lanreotide 40 mg PR groups, respectively. In the lanreotide autogel group, 45.5% (25/55) patients achieved ≥20% reduction in TV compared with 50.9% (25/53) in lanreotide 40 mg PR group (ITT). Safety profiles were similar in both treatment groups. CONCLUSIONS Lanreotide autogel was non-inferior to lanreotide 40 mg PR in Chinese patients with active acromegaly after 32 weeks of treatment. TRIAL REGISTRATION Retrospectively registered on ClinicalTrials.gov: NCT02493517 (9 July 2015); prospectively registered on chinadrugtrials.org.cn: CTR20140698 (24 October 2014).
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Affiliation(s)
- Zhenmei An
- West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ting Lei
- Tongji Hospital, Tongji Medical college of HUST, Wuhan, China
| | - Lian Duan
- Peking Union Medical College Hospital, PUMCH, No.1 Shuaifuyuan, Wangfujing, Dongcheng District, Beijing, 100730, China
| | - Pei Hu
- Peking Union Medical College Hospital, PUMCH, No.1 Shuaifuyuan, Wangfujing, Dongcheng District, Beijing, 100730, China
| | - Zhongping Gou
- West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Lihui Zhang
- The second hospital of Hebei Medical University, Shijiazhuang, China
| | | | | | | | - Feng Gu
- Peking Union Medical College Hospital, PUMCH, No.1 Shuaifuyuan, Wangfujing, Dongcheng District, Beijing, 100730, China.
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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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Colao A, Grasso LFS, Di Cera M, Thompson-Leduc P, Cheng WY, Cheung HC, Duh MS, Neary MP, Pedroncelli AM, Maamari R, Pivonello R. Association between biochemical control and comorbidities in patients with acromegaly: an Italian longitudinal retrospective chart review study. J Endocrinol Invest 2020; 43:529-538. [PMID: 31741320 PMCID: PMC7067716 DOI: 10.1007/s40618-019-01138-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 10/26/2019] [Indexed: 12/17/2022]
Abstract
PURPOSE Achieving biochemical control (normalization of insulin-like growth factor-1 [IGF-1] and growth hormone [GH]) is a key goal in acromegaly management. However, IGF-1 and GH fluctuate over time. The true potential impact of time-varying biochemical control status on comorbidities is unclear and relies on multiple, longitudinal IGF-1 and GH measurements. This study assessed the association between time-varying biochemical control status and onset of selected comorbidities in patients with acromegaly. METHODS Medical charts of adults with confirmed acromegaly and ≥ 6 months of follow-up at an Italian endocrinology center were reviewed. Patients were followed from the first diagnosis of acromegaly at the center until loss to follow-up, chart abstraction, or death. Biochemical control status was assessed annually and defined as IGF-1 ≤ the upper limit of normal, or GH ≤ 2.5 µg/L in the few cases where IGF-1 was unavailable. Time-varying Cox models were used to assess the association between biochemical control status and comorbidities. RESULTS Among 150 patients, 47% were female, average age at diagnosis was 43.1, and mean length of follow-up was 10.4 years. Biochemical control was significantly associated with a lower hazard of diabetes (HR = 0.36, 95% CI 0.15; 0.83) and cardiovascular system disorders (HR = 0.54, 95% CI 0.31; 0.93), and a higher hazard of certain types of arthropathy (HR = 1.68, 95% CI 1.04; 2.71); associations for other comorbidities did not reach statistical significance. CONCLUSION Results further support the importance of achieving biochemical control, as this may reduce the risk of high-burden conditions, including diabetes and cardiovascular system disorders. The association for arthropathy suggests irreversibility of this impairment. Due to limitations, caution is required when interpreting these results.
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Affiliation(s)
- A Colao
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, Via S. Pansini 5, 80131, Naples, Italy.
| | - L F S Grasso
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, Via S. Pansini 5, 80131, Naples, Italy
| | - M Di Cera
- Dipartimento di Medicina e Scienze della Saluta di V. Tiberio, Università degli Studi del Molise, Campobasso, Italy
| | | | - W Y Cheng
- Analysis Group, Inc., Boston, MA, USA
| | | | - M S Duh
- Analysis Group, Inc., Boston, MA, USA
| | - M P Neary
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | | | - R Maamari
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - R Pivonello
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, Via S. Pansini 5, 80131, Naples, Italy
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Cunha MLVD, Borba LAB, Boguszewski CL. Random Gh and Igf-I levels after transsphenoidal surgery for acromegaly: relation with long-term remission. Endocrine 2020; 68:182-191. [PMID: 32078118 DOI: 10.1007/s12020-020-02227-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Accepted: 02/11/2020] [Indexed: 12/12/2022]
Abstract
PURPOSE To evaluate the role of IGF-I and random GH measurements 3 months after transsphenoidal surgery (TSS) in predicting long-term remission in acromegaly patients. METHODS Retrospective analysis of 54 acromegaly patients who underwent TSS with the same neurosurgery team. Random GH and IGF-I values evaluated 3 months after TSS were related to long-term outcomes. The initiation of adjuvant therapy at any time defined surgical failure. RESULTS At 3 months, 14 (25.9%) patients had controlled disease (CD; normal IGF-I and GH < 1.0 µg/L), 25 (46.3%) had uncontrolled disease (UD; high IGF-I and GH), and 15 (27.8%) had biochemical discrepancies (BD): 12 BDI (normal IGF-I + GH ≥ 1.0 μg/L) and 3 BDII (high IGF-I + GH < 1.0 μg/L). All patients of the CD group, 2 of the UD, 11 of the BDI, and 2 of the BDII, progressed with long-term remission and had IGF-I ≤ 1.25-fold the Upper Limit of Normal (ULN), in contrast with all cases of surgical failure where IGF-I was ≥1.3-fold ULN. Only one patient with normal IGF-I had recurrence, resulting in 100% sensitivity and 96% specificity of post-surgical IGF-I ≤ 1.25-fold ULN to predict long-term remission, observed in 54% of our cohort. Post-surgical random GH ≥ 1.7 µg/L was the best cutoff to identify surgical failure, but its accuracy to predict long-term outcomes was limited. CONCLUSIONS IGF-I levels ≤ 1.25-fold ULN 3 months after TSS was the best guide for long-term remission in acromegaly patients with both initial surgical failure and discrepant biochemical results.
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Affiliation(s)
- Marcelo Lemos Vieira da Cunha
- Department of Neurosurgery, Hospital de Clínicas, Universidade Federal do Parana, Rua General Carneiro 181 - Alto da Glória, Curitiba, PR, 80060-900, Brazil
| | - Luis Alencar Biurrum Borba
- Department of Neurosurgery, Hospital de Clínicas, Universidade Federal do Parana, Rua General Carneiro 181 - Alto da Glória, Curitiba, PR, 80060-900, Brazil
| | - Cesar Luiz Boguszewski
- Endocrine Division (SEMPR), Department of Internal Medicine, Hospital de Clínicas, Universidade Federal do Parana, Avenida Agostinho Leao Junior, 285, Curitiba, PR, 80030-110, Brazil.
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Caulley L, Quinn JG, Doyle MA, Alkherayf F, Kilty S, Hunink MGM. Surgical and non-surgical interventions for primary and salvage treatment of growth hormone-secreting pituitary adenomas in adults. Hippokratia 2020. [DOI: 10.1002/14651858.cd013561] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Lisa Caulley
- University of Ottawa, Ottawa Hospital Research Institute; Department of Otolaryngology - Head and Neck Surgery; 500 Smyth Road Ottawa Ontario Canada N4K7A2
| | - Jason G Quinn
- Dalhousie University; Department of Pathology and Laboratory Medicine; 5788 University Avenue Halifax Nova Scotia Canada B3H 1V8
| | - Mary-Anne Doyle
- University of Ottawa; Endocrinology and Metabolism; Ottawa Ontario Canada
| | - Fahad Alkherayf
- The Ottawa Hospital; Neurosurgery; 1053 Carling Avenue, Room C2118 Ottawa Ontario Canada K1Y 4E9
| | - Shaun Kilty
- University of Ottawa; Department of Otolaryngology - Head and Neck Surgery; 132-737 Parkdale Avenue Ottawa ON Canada K1Y 1J8
| | - M G Myriam Hunink
- Erasmus MC; Department of Epidemiology; PO Box 2040 Rotterdam Netherlands 3000 CA
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Parolin M, Dassie F, Vettor R, Maffei P. Acromegaly and ultrasound: how, when and why? J Endocrinol Invest 2020; 43:279-287. [PMID: 31502218 DOI: 10.1007/s40618-019-01111-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 09/03/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND Acromegaly is a rare disease caused by an excess of growth hormone and insulin-like growth factor 1. It is usually diagnosed because of typical signs such as macroglossia, acral enlargement, jaw prognathism and malocclusion. Systemic complications are a major cause of morbidity and mortality in acromegaly, and many patients remain undiagnosed for several years. Increased ultrasound (US) application in the general population, and including among acromegaly patients, has revealed many suggestive features which, taken together with clinical suspicion, could induce suspicion of this disease. PURPOSE This review describes main US features in acromegaly. Echocardiography shows a typical cardiomyopathy, characterized by left ventricular hypertrophy, diastolic and systolic dysfunction, aortic and mitral regurgitation, and increased aortic root diameters. US preclinical markers of atherosclerosis, such as intima media thickness (IMT), seem also to be impaired. Visceromegaly and increased organ stiffness are other features of acromegaly, including enlarged prostate, kidneys, liver, and thyroid. In addition, other US findings are: renal cysts, micronephrolithiasis, impairment of renal haemodynamic parameters, gallstones and gallbladder polyps, hepatic steatosis, thyroid nodules, multinodular goiter, and polycystic ovaries. Musculoskeletal US findings are increased cartilage thickness, impaired density and elasticity of bones, nerve enlargement, carpal and cubital tunnel syndrome, and trigger finger. CONCLUSIONS Acromegaly patients frequently present systemic complications and a diagnostic delay. US features of acromegaly are not specific, but could potentially have a key role in early detection of the disease in the presence of typical clinical features.
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Affiliation(s)
- M Parolin
- Clinica Medica 3, Department of Medicine (DIMED), University of Padua, via Giustiniani 2, 35128, Padua, Italy.
| | - F Dassie
- Clinica Medica 3, Department of Medicine (DIMED), University of Padua, via Giustiniani 2, 35128, Padua, Italy
| | - R Vettor
- Clinica Medica 3, Department of Medicine (DIMED), University of Padua, via Giustiniani 2, 35128, Padua, Italy
| | - P Maffei
- Clinica Medica 3, Department of Medicine (DIMED), University of Padua, via Giustiniani 2, 35128, Padua, Italy
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Cozzi R, Ambrosio MR, Attanasio R, Bozzao A, De Marinis L, De Menis E, Guastamacchia E, Lania A, Lasio G, Logoluso F, Maffei P, Poggi M, Toscano V, Zini M, Chanson P, Katznelson L. Italian Association of Clinical Endocrinologists (AME) and Italian AACE Chapter Position Statement for Clinical Practice: Acromegaly - Part 1: Diagnostic and Clinical Issues. Endocr Metab Immune Disord Drug Targets 2020; 20:1133-1143. [PMID: 31985386 PMCID: PMC7579251 DOI: 10.2174/1871530320666200127103320] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 12/05/2019] [Accepted: 12/05/2019] [Indexed: 12/21/2022]
Abstract
Acromegaly is a rare disease. Improvements in lifespan in these patients have recently been reported due to transsphenoidal surgery (TSS), advances in medical therapy, and strict criteria for defining disease remission. This document reports the opinions of a group of Italian experts who have gathered together their prolonged clinical experience in the diagnostic and therapeutic challenges of acromegaly patients. Both GH and IGF-I (only IGF-I in those treated with Pegvisomant) are needed in the diagnosis and follow-up. Comorbidities (cardio-cerebrovascular disease, sleep apnea, metabolic derangement, neoplasms, and bone/joint disease) should be specifically addressed. Any newly diagnosed patient should be referred to a multidisciplinary team experienced in the treatment of pituitary adenomas.
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Affiliation(s)
- Renato Cozzi
- Address correspondence to this author at the Endocrinologia, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162 Milano, Italy; Tel: +39.347.5225490; E-mail:
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Gu J, Xiang S, He M, Wang M, Gu Y, Li L, Yin Z. Quality of Life in Patients with Acromegaly before and after Transsphenoidal Surgical Resection. Int J Endocrinol 2020; 2020:5363849. [PMID: 32831834 PMCID: PMC7424368 DOI: 10.1155/2020/5363849] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 07/08/2020] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE We aimed to determine the perioperative changes in the quality of life (QoL) in patients with acromegaly and to reveal the relationship between biochemical indicators and quality of life change after tumor resection. METHODS Patients with acromegaly were enrolled from a tertiary pituitary center. SF-36 scale and AcroQoL scale were used to determine the QoL before and after surgery. We analyzed changes in QoL using a generalized linear model for repeated measurements. We compared the changes in QoL among three groups (remission, active, and discordant group) based on postoperative growth hormone (GH) and insulin-like growth factor-1. RESULTS 151 patients (75 males and 76 females) diagnosed with acromegaly were included. The average age was 43.9 ± 12.3 years. The median total SF-36 scale was 65.3% (IQR: 63.2%-69.2%). Overall AcroQoL score at baseline was 59.1% (IQR: 51.8%-71.8%). Nadir GH levels (coefficient -0.08, p=0.047), T3 levels (coefficient 2.8, p=0.001), and testosterone levels (coefficient -0.20, p=0.033) in males were independent predictive factors of the total SF-36 score. During the follow-up, the median overall SF-36 score increased to 66.1% at 3 months and 75.3% at 6 months (p < 0.001) after surgery. The median overall AcroQoL score increased to 74.5% at 3 months and 77.3% at 6 months (p < 0.001) after surgery. At 6-month follow-up, median scores were still less than 70% in appearance, vitality, and mental health dimensions. The QoL after surgery were similar among the three groups, although higher GH and more preoperative somatostatin analogs usage were observed in the active group. CONCLUSION In conclusion, acromegalic patients were associated with low QoL, which could be reversed partially by surgery. The improvement was independent of the endocrine remission. Appearance, vitality, and mental health were three major aspects that warrant further attention from physicians and caregivers after surgery.
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Affiliation(s)
- Jing Gu
- Department of Nursery, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Shiyuan Xiang
- Department of Nursery, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Min He
- Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Meng Wang
- Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Yanfang Gu
- Department of Nursery, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Lingjuan Li
- Department of Nursery, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Zhiwen Yin
- Department of Nursery, Huashan Hospital, Fudan University, Shanghai 200040, China
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Ding D, Mehta GU, Patibandla MR, Lee CC, Liscak R, Kano H, Pai FY, Kosak M, Sisterson ND, Martinez-Alvarez R, Martinez-Moreno N, Mathieu D, Grills IS, Blas K, Lee K, Cifarelli CP, Katsevman GA, Lee JYK, McShane B, Kondziolka D, Lunsford LD, Vance ML, Sheehan JP. Stereotactic Radiosurgery for Acromegaly: An International Multicenter Retrospective Cohort Study. Neurosurgery 2020; 84:717-725. [PMID: 29757421 DOI: 10.1093/neuros/nyy178] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 04/05/2018] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Stereotactic radiosurgery (SRS) is a treatment option for persistent or recurrent acromegaly secondary to a growth hormone secreting pituitary adenoma, but its efficacy is inadequately defined. OBJECTIVE To assess, in a multicenter, retrospective cohort study, the outcomes of SRS for acromegaly and determine predictors. METHODS We pooled and analyzed data from 10 participating institutions of the International Gamma Knife Research Foundation for patients with acromegaly who underwent SRS with endocrine follow-up of ≥6 mo. RESULTS The study cohort comprised 371 patients with a mean endocrine follow-up of 79 mo. IGF-1 lowering medications were held in 56% of patients who were on pre-SRS medical therapy. The mean SRS treatment volume and margin dose were 3.0 cm3 and 24.2 Gy, respectively. The actuarial rates of initial and durable endocrine remission at 10 yr were 69% and 59%, respectively. The mean time to durable remission after SRS was 38 mo. Biochemical relapse after initial remission occurred in 9%, with a mean time to recurrence of 17 mo. Cessation of IGF-1 lowering medication prior to SRS was the only independent predictor of durable remission (P = .01). Adverse radiation effects included the development of ≥1 new endocrinopathy in 26% and ≥1 cranial neuropathy in 4%. CONCLUSION SRS is a definitive treatment option for patients with persistent or recurrent acromegaly after surgical resection. There appears to be a statistical association between the cessation of IGF-1 lowering medications prior to SRS and durable remission.
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Affiliation(s)
- Dale Ding
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona
| | - Gautam U Mehta
- Department of Neurosurgery, MD Anderson Cancer Center, Houston, Texas
| | | | - Cheng-Chia Lee
- Department of Neurosurgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Roman Liscak
- Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
| | - Hideyuki Kano
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Fu-Yuan Pai
- Department of Neurosurgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Mikulas Kosak
- 3rd Department of Medicine, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Nathaniel D Sisterson
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | | | - David Mathieu
- Division of Neurosurgery, Centre de recherche du CHUS, University of Sherbrooke, Sherbrooke, Quebec, Canada
| | - Inga S Grills
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, Michigan
| | - Kevin Blas
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, Michigan
| | - Kuei Lee
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, Michigan
| | | | | | - John Y K Lee
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Brendan McShane
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Douglas Kondziolka
- Department of Neurosurgery, New York University Langone Medical Center, New York, New York
| | - L Dade Lunsford
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Mary Lee Vance
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia.,Department of Medicine, University of Virginia, Charlottesville, Virginia
| | - Jason P Sheehan
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
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Calan M, Demirpence M. Increased circulating levels of irisin are associated with cardiovascular risk factors in subjects with acromegaly. Hormones (Athens) 2019; 18:435-442. [PMID: 31696447 DOI: 10.1007/s42000-019-00151-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 10/23/2019] [Indexed: 02/07/2023]
Abstract
AIMS Irisin, a peptide secreted from muscle and adipose tissues, is associated with insulin resistance as well as metabolic and cardiovascular diseases. Acromegaly is a rare disorder caused by overproduction of growth hormone (GH) and is associated with functional and structural differentiation of adipose and muscle tissues. Acromegalic subjects are also at risk of vascular diseases and metabolic dysfunctions. We aimed to determine the altered levels of irisin in subjects with active acromegaly and controlled acromegaly and in controls, and to ascertain whether there is an association between irisin and hormonal and cardiometabolic parameters. METHODS We enrolled 40 subjects with active acromegaly, 30 subjects with controlled acromegaly, and 40 control subjects of matched age, gender, BMI, and occurrence of hypertension, diabetes, and metabolic syndrome distribution in the present cross-sectional study. Hormonal and metabolic parameters, carotid intima media thickness (cIMT), and epicardial fat thickness (EFT) of the subjects were evaluated. Irisin levels were measured using ELISA. RESULTS Circulating levels of irisin were significantly higher in acromegalic subjects compared to both controlled acromegalic subjects and controls. Moreover, irisin levels were elevated in controlled acromegalic subjects compared to controls. Irisin displayed a positive correlation with insulin resistance, cIMT, EFT, BMI, GH, and insulin-like growth factor (IGF-1) in acromegalic subjects. Irisin levels were independently associated with cIMT and EFT according to multiple regression analyses. There was an independent relationship between irisin and IGF-1. CONCLUSIONS Elevated irisin levels in acromegalic subjects were associated with cIMT and EFT, suggesting that irisin is a surrogate marker for cardiovascular risk in acromegalic subjects.
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Affiliation(s)
- Mehmet Calan
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Izmir Bozyaka Training and Research Hospital, Bozyaka, 35170, Izmir, Turkey.
| | - Mustafa Demirpence
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Izmir Tepecik Training and Research Hospital, Tepecik, 35120, Izmir, Turkey
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Fogacci F, Borghi C, Cicero AFG. Portrait of the Countess Anastasia Spini (1842): acromegaly in art. Hormones (Athens) 2019; 18:517-518. [PMID: 31630371 DOI: 10.1007/s42000-019-00136-2] [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: 07/03/2019] [Accepted: 09/12/2019] [Indexed: 11/25/2022]
Affiliation(s)
- Federica Fogacci
- Medical and Surgical Sciences Department, University of Bologna, Bologna, Italy
| | - Claudio Borghi
- Medical and Surgical Sciences Department, University of Bologna, Bologna, Italy
| | - Arrigo F G Cicero
- Medical and Surgical Sciences Department, University of Bologna, Bologna, Italy.
- Medical and Surgical Sciences Department, Sant'Orsola-Malpighi University Hospital, Via Albertoni 15, 40138, Bologna, Italy.
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Alexandraki KI, Papadimitriou E, Mavroeidi V, Kyriakopoulos G, Xydakis A, Papaioannou TG, Kolomodi D, Kaltsas GA, Grossman AB. Role of Receptor Profiling for Personalized Therapy in a Patient with a Growth Hormone-Secreting Macroadenoma Resistant to First-Generation Somatostatin Analogues. J Pers Med 2019; 9:jpm9040048. [PMID: 31731613 PMCID: PMC6963904 DOI: 10.3390/jpm9040048] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 11/10/2019] [Accepted: 11/12/2019] [Indexed: 11/23/2022] Open
Abstract
Background: Acromegaly is almost always caused by a pituitary adenoma and is associated with high morbidity and mortality when uncontrolled. Trans-sphenoidal removal of the adenoma is the mainstay of therapy, but fails to control the disease in a significant number of patients who require further treatment. Somatostatin analogues (SSAs) as monotherapy or in combination with growth hormone (GH)-receptor antagonists and/or dopamine agonists are used either alone or in combination following surgical failure to achieve disease control. The use of specific biomarkers may help to individualize the therapeutic plan after surgical failure and direct towards a more personalized approach. Methods: We report a 41-year-old man with acromegaly and residual disease after repeated surgery that was resistant to first-generation SSAs. Results: Biochemical and tumor control were achieved following the administration of a second-generation SSA, pasireotide, combined with pegvisomant, both at maximal doses and along with cabergoline. Histology specimens showed a sparsely-granulated GH-immunostaining pituitary adenoma with intense positivity for somatostatin receptors 2 and 5 and low levels of E-cadherin. Conclusion: Personalized medical therapy guided by currently available biomarkers, such as immunohistochemically-characterized receptor profiling or adhesion molecules, resulted in controlled insulin-like growth factor-1 (IGF-1) and GH levels and symptom alleviation following the combination of three drug-classes.
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Affiliation(s)
- Krystallenia I. Alexandraki
- Endocrine Unit, 1st Department of Propaedeutic Medicine, Laiko Hospital, Medical School, National and Kapodistrian University of Athens, 115 27 Athens, Greece; (E.P.); (V.M.); (A.X.); (D.K.); (G.A.K.)
- Correspondence:
| | - Eirini Papadimitriou
- Endocrine Unit, 1st Department of Propaedeutic Medicine, Laiko Hospital, Medical School, National and Kapodistrian University of Athens, 115 27 Athens, Greece; (E.P.); (V.M.); (A.X.); (D.K.); (G.A.K.)
| | - Vasiliki Mavroeidi
- Endocrine Unit, 1st Department of Propaedeutic Medicine, Laiko Hospital, Medical School, National and Kapodistrian University of Athens, 115 27 Athens, Greece; (E.P.); (V.M.); (A.X.); (D.K.); (G.A.K.)
| | | | - Antonios Xydakis
- Endocrine Unit, 1st Department of Propaedeutic Medicine, Laiko Hospital, Medical School, National and Kapodistrian University of Athens, 115 27 Athens, Greece; (E.P.); (V.M.); (A.X.); (D.K.); (G.A.K.)
| | - Theodoros G. Papaioannou
- First Department of Cardiology, Medical School, National and Kapodistrian University of Athens, 115 27 Athens, Greece;
| | - Denise Kolomodi
- Endocrine Unit, 1st Department of Propaedeutic Medicine, Laiko Hospital, Medical School, National and Kapodistrian University of Athens, 115 27 Athens, Greece; (E.P.); (V.M.); (A.X.); (D.K.); (G.A.K.)
| | - Gregory A. Kaltsas
- Endocrine Unit, 1st Department of Propaedeutic Medicine, Laiko Hospital, Medical School, National and Kapodistrian University of Athens, 115 27 Athens, Greece; (E.P.); (V.M.); (A.X.); (D.K.); (G.A.K.)
| | - Ashley B. Grossman
- Centre for Endocrinology, William Harvey Institute, Barts and the London School of Medicine, E1 2AT London, UK;
- Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, OX3 7LE Oxford, UK
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Coopmans EC, van Meyel SWF, van der Lely AJ, Neggers SJCMM. The position of combined medical treatment in acromegaly. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2019; 63:646-652. [PMID: 31939490 PMCID: PMC10522231 DOI: 10.20945/2359-3997000000195] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 11/19/2019] [Indexed: 11/23/2022]
Abstract
Advances in combination medical treatment have offer new perspectives for acromegaly patients with persistent disease activity despite receiving the available medical monotherapies. The outcomes of combination medical treatment may reflect both additive and synergistic effects. This review focuses on combination medical treatment and its current position in acromegaly, based on clinical studies evaluating the efficacy and safety of combined medical treatment(s) and our own experiences with combination therapy. Arch Endocrinol Metab. 2019;63(6):646-52.
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Affiliation(s)
- Eva C. Coopmans
- Section EndocrinologyPituitary Center RotterdamErasmus University Medical Center RotterdamRotterdamNetherlandsDepartment of Medicine, Section Endocrinology, Pituitary Center Rotterdam, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Sebastiaan W. F. van Meyel
- Section EndocrinologyPituitary Center RotterdamErasmus University Medical Center RotterdamRotterdamNetherlandsDepartment of Medicine, Section Endocrinology, Pituitary Center Rotterdam, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Aart J van der Lely
- Section EndocrinologyPituitary Center RotterdamErasmus University Medical Center RotterdamRotterdamNetherlandsDepartment of Medicine, Section Endocrinology, Pituitary Center Rotterdam, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Sebastian J. C. M. M. Neggers
- Section EndocrinologyPituitary Center RotterdamErasmus University Medical Center RotterdamRotterdamNetherlandsDepartment of Medicine, Section Endocrinology, Pituitary Center Rotterdam, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
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Alonso CE, Bunevicius A, Trifiletti DM, Larner J, Lee CC, Pai FY, Liscak R, Kosak M, Kano H, Sisterson ND, Mathieu D, Lunsford LD, Sheehan JP. Safety and efficacy of repeat radiosurgery for acromegaly: an International Multi-Institutional Study. J Neurooncol 2019; 145:301-307. [PMID: 31541405 DOI: 10.1007/s11060-019-03296-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 09/17/2019] [Indexed: 01/18/2023]
Abstract
PURPOSE Surgical resection is the first line treatment for growth hormone (GH) secreting tumors. Stereotactic radiosurgery (SRS) is recommended for patients who do not achieve endocrine remission after resection. The purpose of this study was to evaluate safety and efficacy of repeat radiosurgery for acromegaly. METHODS Three hundred and ninety-eight patients with acromegaly treated with the Gamma Knife radiosurgery (Elekta AB, Stockholm) were identified from the International Gamma Knife Research Foundation database. Among these, 21 patients underwent repeated SRS with sufficient endocrine follow-up and 18 patients had sufficient imaging follow-up. Tumor control was defined as lack of adenoma progression on imaging. Endocrine remission was defined as a normal IGF-1 concentration while off medical therapy. RESULTS Median time from initial SRS to repeat SRS was 5.0 years. The median imaging and endocrine follow-up duration after repeat SRS was 3.4 and 3.8 years, respectively. The median initial marginal dose was 17 Gy, and the median repeat marginal dose was 23 Gy. Of the 18 patients with adequate imaging follow up, 15 (83.3%) patients had tumor control and of 21 patients with endocrine follow-up, 9 (42.9%) patients had endocrine remission at last follow-up visit. Four patients (19.0%) developed new deficits after repeat radiosurgery. Of these, 3 patients had neurologic deficits and 1 patient had endocrine deficit. CONCLUSIONS Repeat radiosurgery for persistent acromegaly offers a reasonable benefit to risk profile for this challenging patient cohort. Further studies are needed to identify patients best suited for this type of approach.
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Affiliation(s)
- Clayton E Alonso
- Department of Radiation Oncology, University of Virginia, Charlottesville, VA, USA
| | - Adomas Bunevicius
- Department of Neurosurgery, University of Virginia, Charlottesville, VA, USA
| | | | - James Larner
- Department of Radiation Oncology, University of Virginia, Charlottesville, VA, USA
| | - Cheng-Chia Lee
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Fu-Yuan Pai
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Roman Liscak
- Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
| | - Mikulas Kosak
- 3rd Department of Medicine, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Hideyuki Kano
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - David Mathieu
- Division of Neurosurgery, Centre de Recherche du CHUS, University of Sherbrooke, Sherbrooke, QC, Canada
| | - L Dade Lunsford
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA
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Ugur K, Karatas A, Oz B, Artas H, Aydin S, Koca SS. Imaging of sacroiliac joints in patients with acromegaly. Sci Rep 2019; 9:11645. [PMID: 31406221 PMCID: PMC6691114 DOI: 10.1038/s41598-019-48250-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 08/01/2019] [Indexed: 11/17/2022] Open
Abstract
Acromegaly can lead to structural alterations of joints and bones. Patients with acromegaly may, therefore, have musculoskeletal complaints. In this study, sacroiliac joints are investigated in patients with acromegaly. 33 patients with acromegaly were enrolled. Sacroiliac joints were examined by X-ray and magnetic resonance imaging (MRI). In acromegaly, sacroiliac joints were abnormal in 36% of the patients by X-ray and 12.1% by MRI. When current axial spondylarthritis (SpA) classification criteria were taken into account, 6.1% of acromegaly patients could be classified as non-radiographic axial SpA and 2% as radiographic axial SpA. Sacroiliac joints are frequently affected in acromegaly and thus this disorder mimics the features of AS and SpA. Acromegaly should be kept in mind in the differential diagnosis of AS and SpA.
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Affiliation(s)
- Kader Ugur
- Department of Endocrinology and Metabolism Diseases, Firat University School of Medicine, Elazig, Turkey
| | - Ahmet Karatas
- Department of Rheumatology, Firat University School of Medicine, Elazig, Turkey.
| | - Burak Oz
- Department of Rheumatology, Firat University School of Medicine, Elazig, Turkey
| | - Hakan Artas
- Department of Radiology, Firat University School of Medicine, Elazig, Turkey
| | - Suleyman Aydin
- Department of Medical Biochemistry and Clinical Biochemistry, Firat Hormones Research Group, Firat University School of Medicine, Elazig, Turkey
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Polat Korkmaz O, Gurcan M, Nuhoglu Kantarci FE, Haliloglu O, Ozkaya HM, Sahin S, Oren MM, Tanriover N, Gazioglu N, Kadioglu P. The effects of pre-operative somatostatin analogue therapy on treatment cost and remission in acromegaly. Pituitary 2019; 22:387-396. [PMID: 31098838 DOI: 10.1007/s11102-019-00968-6] [Citation(s) in RCA: 4] [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: 10/26/2022]
Abstract
PURPOSE To investigate the effects of preoperative somatostatin analogue (SSA) treatment on the annual cost of all acromegaly treatment modalities and on remission rates. METHODS The medical records of 135 patients with acromegaly who were followed at endocrinology clinic of Cerrahpasa Medical Faculty for at least 2 years after surgery between 2009 and 2016 were reviewed. RESULTS The mean follow-up time was 50.9 ± 25.7 months. Early remission was defined according to 3rd month values in patients who didn't achieve remission, and 6th month values in patients who achieved remission at the 3rd month after surgery. The early and late remission rates of the entire study population were 40% and 80.7%, respectively. The early remission of the preoperative SSA-treated group (61.5%) was significantly higher than SSA-untreated group (31.2%) (p = 0.002). The early remission of the preoperative SSA-treated patients with macroadenomas (52.2%) was also significantly higher than the SSA-untreated group (23.5%) (p = 0.02). In the subgroup analysis; this difference was much more pronounced in invasive macroadenomas (p = 0.002). There were no differences between the groups in terms of late remission.The median annual cost of all acromegaly treatment modalities in study population was €3788.4; the cost for macroadenomas was significantly higher than for microadenomas (€4125.0 vs. €3226.5, respectively; p = 0.03). Preoperative SSA use in both microadenomas and macroadenomas didn't alter the cost of treatment. The increase in the duration of preoperative medical treatment had no effect on early or late remissions (p = 0.09; p = 0.8). CONCLUSIONS Preoperative medical treatment had no effect on the costs of acromegaly treatment. There was a benefical effect of pre-operative SSA use on early remission in patients with macroadenomas; however, this effect didn't persist long term.
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Affiliation(s)
- Ozge Polat Korkmaz
- Division of Endocrinology, Metabolism and Diabetes, Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Kocamustafapasa Street No:53, Fatih, 34098, Istanbul, Turkey
| | - Mert Gurcan
- Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | | | - Ozlem Haliloglu
- Division of Endocrinology, Metabolism and Diabetes, Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Kocamustafapasa Street No:53, Fatih, 34098, Istanbul, Turkey
| | - Hande Mefkure Ozkaya
- Division of Endocrinology, Metabolism and Diabetes, Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Kocamustafapasa Street No:53, Fatih, 34098, Istanbul, Turkey
| | - Serdar Sahin
- Division of Endocrinology, Metabolism and Diabetes, Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Kocamustafapasa Street No:53, Fatih, 34098, Istanbul, Turkey
| | | | - Necmettin Tanriover
- Department of Neurosurgery, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Nurperi Gazioglu
- Department of Neurosurgery, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Pinar Kadioglu
- Division of Endocrinology, Metabolism and Diabetes, Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Kocamustafapasa Street No:53, Fatih, 34098, Istanbul, Turkey.
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Wani RUH, Misgar RA, Bhat MH, Bhat JA, Masoodi SR, Bashir MI, Wani AI. Presentation, Morbidity and Treatment Outcome of Acromegaly Patients at a Single Centre. Indian J Endocrinol Metab 2019; 23:433-437. [PMID: 31741902 PMCID: PMC6844178 DOI: 10.4103/ijem.ijem_132_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION The management of acromegaly, a rare and potentially curable disease, has undergone a paradigm shift in the past few decades. Many of the treatment modalities recommended for acromegaly are either too expensive or not available in many parts of India. There is a dearth of treatment and outcome data in Indian patients. AIM Our aim was to study the clinical presentation, hormonal profile, radiology, management, and outcome of the disease at our center. MATERIALS AND METHODS Fifty one patients with acromegaly who attended the Department of Endocrinology, SKIMS, Srinagar, between October 2015 and April 2017, were included in the study. Clinical and hormonal profiles, comorbidities, treatment modalities, and outcome were evaluated. RESULTS The gender distribution was equal with the mean age of 42.3 ± 10.9 years at diagnosis. The majority (41) of the patients had macroadenoma. The most common presenting manifestations were acral enlargement and headache. Hypertension was present in 23, musculoskeletal manifestations in 19, and diabetes mellitus in 11 patients. Surgery was the most common method of treatment. Preoperatively only one patient with micro-adenoma had hypocortisolism, which was persistent in postoperative period, while no patient had preoperative or postoperative hypothyroidism or hypogonadism. As per the present consensus criteria, 23.7% patients achieved disease control (40% with microadenoma and only 19.5% with macroadenoma). The surgical complications occurred in 5 patients-CSF leak in 3 meningitis in 2 patients all except one having macroadenoma. CONCLUSIONS The presentation of disease was generally comparable to that reported in literature. Cure rates were significantly lower than those reported from many large centers.
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Affiliation(s)
- Rayees Ul Hamid Wani
- Department of Endocrinology, Sheri Kashmir Institute of Medical Sciences, Srinagar, Kashmir, India
| | - Raiz Ahmad Misgar
- Department of Endocrinology, Sheri Kashmir Institute of Medical Sciences, Srinagar, Kashmir, India
| | - Moomin Hussain Bhat
- Department of Endocrinology, Sheri Kashmir Institute of Medical Sciences, Srinagar, Kashmir, India
| | - Javaid Ahmad Bhat
- Department of Endocrinology, Sheri Kashmir Institute of Medical Sciences, Srinagar, Kashmir, India
| | - Shariq Rashid Masoodi
- Department of Endocrinology, Sheri Kashmir Institute of Medical Sciences, Srinagar, Kashmir, India
| | - Mir Iftikhar Bashir
- Department of Endocrinology, Sheri Kashmir Institute of Medical Sciences, Srinagar, Kashmir, India
| | - Arshad Iqbal Wani
- Department of Endocrinology, Sheri Kashmir Institute of Medical Sciences, Srinagar, Kashmir, India
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Harada K, Hasegawa K, Otsuka F. Swollen Hands and "Fist Sign" in Acromegaly. Am J Med 2019; 132:e618-e619. [PMID: 30853479 DOI: 10.1016/j.amjmed.2019.02.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 02/18/2019] [Indexed: 11/16/2022]
Affiliation(s)
- Ko Harada
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Kitaku, Okayama, Japan.
| | - Kou Hasegawa
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Kitaku, Okayama, Japan
| | - Fumio Otsuka
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Kitaku, Okayama, Japan
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Coopmans EC, Muhammad A, van der Lely AJ, Janssen JAMJL, Neggers SJCMM. How to Position Pasireotide LAR Treatment in Acromegaly. J Clin Endocrinol Metab 2019; 104:1978-1988. [PMID: 30608534 DOI: 10.1210/jc.2018-01979] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 12/28/2018] [Indexed: 02/13/2023]
Abstract
CONTEXT Pasireotide long-acting release (LAR) is a somatostatin multireceptor ligand, and in the current consensus criteria pasireotide LAR is considered the second-line medical treatment for acromegaly. We present in this article our recommendations to define the position of pasireotide LAR in the treatment of acromegaly and provide recommendations for the management of pasireotide-induced hyperglycemia. EVIDENCE ACQUISITION Our recommendations are based on our experiences with the pasireotide LAR and pegvisomant (PEGV) combination study and the available basic or clinical articles published in peer-reviewed international journals on pasireotide LAR and acromegaly. EVIDENCE SYNTHESIS In accordance with the current consensus criteria, we recommend pasireotide LAR monotherapy as a second-line therapy in young patients who show tumor growth during first-generation somatostatin receptor ligand (SRL) therapy and in patients who show tumor growth during PEGV therapy. In addition, we recommend pasireotide LAR monotherapy in patients with headache not responsive to first-generation SRL therapy and in patients who experience side effects or are intolerant to PEGV monotherapy. In contrast to the current consensus criteria, we recommend considering combination therapy with pasireotide LAR and PEGV as third-line treatment in patients without diabetes at low PEGV dosages (≤80 mg/week) and in patients with tumor growth or symptoms of active acromegaly during first-generation SRL and PEGV combination therapy. With respect to pasireotide-induced hyperglycemia, we recommend a more liberal strategy of blood glucose monitoring during pasireotide treatment. CONCLUSIONS In contrast to the current consensus criteria, we recommend a more reluctant use of pasireotide LAR therapy for the treatment of acromegaly.
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Affiliation(s)
- Eva C Coopmans
- Department of Internal Medicine, Endocrinology Section, Pituitary Center Rotterdam, Erasmus University Medical Center, CB Rotterdam, Netherlands
| | - Ammar Muhammad
- Department of Internal Medicine, Endocrinology Section, Pituitary Center Rotterdam, Erasmus University Medical Center, CB Rotterdam, Netherlands
| | - Aart J van der Lely
- Department of Internal Medicine, Endocrinology Section, Pituitary Center Rotterdam, Erasmus University Medical Center, CB Rotterdam, Netherlands
| | - Joseph A M J L Janssen
- Department of Internal Medicine, Endocrinology Section, Pituitary Center Rotterdam, Erasmus University Medical Center, CB Rotterdam, Netherlands
| | - Sebastian J C M M Neggers
- Department of Internal Medicine, Endocrinology Section, Pituitary Center Rotterdam, Erasmus University Medical Center, CB Rotterdam, Netherlands
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Michalski ADC, Ferreira ADS, Kasuki L, Gadelha MR, Lopes AJ, Guimarães FS. Clinical and functional variables can predict general fatigue in patients with acromegaly: an explanatory model approach. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2019; 63:235-240. [PMID: 31038594 PMCID: PMC10522193 DOI: 10.20945/2359-3997000000127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Accepted: 01/14/2019] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To evaluate whether hormonal profile, arterial function, and physical capacity are predictors of fatigue in patients with acromegaly. Subjects and methods: This is a cross-sectional study including 23 patients. The subjects underwent a Modified Fatigue Impact Scale (MFIS) assessment; serum growth hormones (GH) and IGF-1 measurements; pulse wave analysis comprising pulse wave velocity (PWV), arterial compliance (AC), and the reflection index (IR1,2); dominant upper limb dynamometry (DYN); and the six-minute walking distance test (6MWT). Multiple linear regression models were used to identify predictors for MFIS. The coefficient of determination R2 was used to assess the quality of the models' fit. The best model was further analyzed using a calibration plot and a limits of agreement (LOA) plot. RESULTS The mean ± SD values for the participants' age, MFIS, PWV, AC, IR1,2, DYN, and the distance in the 6MWT were 49.4 ± 11.2 years, 31.2 ± 18.9 score, 10.19 ± 2.34 m/s, 1.08 ± 0.46 x106 cm5/din, 85.3 ± 29.7%, 33.9 ± 9.3 kgf, and 603.0 ± 106.1 m, respectively. The best predictive model (R2 = 0.378, R2 adjusted = 0.280, standard error = 16.1, and P = 0.026) comprised the following regression equation: MFIS = 48.85 - (7.913 × IGF-I) + (1.483 × AC) - (23.281 × DYN). CONCLUSION Hormonal, vascular, and functional variables can predict general fatigue in patients with acromegaly.
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Affiliation(s)
- André da Cunha Michalski
- Centro Universitário Augusto MottaPrograma de Pós-Graduação em Ciências da ReabilitaçãoCentro Universitário Augusto MottaRio de JaneiroRJBrasilPrograma de Pós-Graduação em Ciências da Reabilitação, Centro Universitário Augusto Motta, Rio de Janeiro, RJ, Brasil
| | - Arthur de Sá Ferreira
- Centro Universitário Augusto MottaPrograma de Pós-Graduação em Ciências da ReabilitaçãoCentro Universitário Augusto MottaRio de JaneiroRJBrasilPrograma de Pós-Graduação em Ciências da Reabilitação, Centro Universitário Augusto Motta, Rio de Janeiro, RJ, Brasil
| | - Leandro Kasuki
- Universidade Federal do Rio de JaneiroFaculdade de MedicinaHospital Universitário Clementino Fraga FilhoUniversidade Federal do Rio de JaneiroRio de JaneiroRJBrasil Centro de Pesquisa em Neuroendocrinologia, Serviço de Endocrinologia, Faculdade de Medicina, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brasil
- Instituto Estadual do Cérebro Paulo NiemeyerSecretaria Estadual de Saúde do Rio de JaneiroRio de JaneiroRJBrasil Divisão de Neuroendocrinologia, Instituto Estadual do Cérebro Paulo Niemeyer, Secretaria Estadual de Saúde do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | - Monica R. Gadelha
- Universidade Federal do Rio de JaneiroFaculdade de MedicinaHospital Universitário Clementino Fraga FilhoUniversidade Federal do Rio de JaneiroRio de JaneiroRJBrasil Centro de Pesquisa em Neuroendocrinologia, Serviço de Endocrinologia, Faculdade de Medicina, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brasil
- Instituto Estadual do Cérebro Paulo NiemeyerSecretaria Estadual de Saúde do Rio de JaneiroRio de JaneiroRJBrasil Divisão de Neuroendocrinologia, Instituto Estadual do Cérebro Paulo Niemeyer, Secretaria Estadual de Saúde do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | - Agnaldo José Lopes
- Centro Universitário Augusto MottaPrograma de Pós-Graduação em Ciências da ReabilitaçãoCentro Universitário Augusto MottaRio de JaneiroRJBrasilPrograma de Pós-Graduação em Ciências da Reabilitação, Centro Universitário Augusto Motta, Rio de Janeiro, RJ, Brasil
| | - Fernando Silva Guimarães
- Centro Universitário Augusto MottaPrograma de Pós-Graduação em Ciências da ReabilitaçãoCentro Universitário Augusto MottaRio de JaneiroRJBrasilPrograma de Pós-Graduação em Ciências da Reabilitação, Centro Universitário Augusto Motta, Rio de Janeiro, RJ, Brasil
- Universidade Federal do Rio de JaneiroDepartamento de FisioterapiaUniversidade Federal do Rio de JaneiroRio de JaneiroRJBrasilDepartamento de Fisioterapia, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brasil
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Dobri G, Niwattisaiwong S, Bena JF, Gupta M, Kirwan J, Kennedy L, Hamrahian AH. Is GH nadir during OGTT a reliable test for diagnosis of acromegaly in patients with abnormal glucose metabolism? Endocrine 2019; 64:139-146. [PMID: 30415402 DOI: 10.1007/s12020-018-1805-z] [Citation(s) in RCA: 4] [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: 07/29/2018] [Accepted: 10/29/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE The growth hormone (GH) nadir during oral glucose tolerance test (OGTT) is the gold standard diagnostic test for acromegaly. The utility of OGTT-GH suppression test in patients with abnormal glucose metabolism (AGM) has not been well established. In this study, we compared the GH nadir during OGTT in patients evaluated for acromegaly in the presence and absence of AGM. METHODS This is a retrospective cohort study of patients with acromegaly (G1, n = 40) and a group in whom acromegaly was not confirmed (G2, n = 53) who had OGTT-GH suppression test during 2000-2012, using a monoclonal GH immunoenzymatic assay. The patients were categorized as having normal glucose metabolism (NGM) or AGM. GH nadir during OGTT in each group were compared. RESULTS In G1 and G2, 17 and 19 patients had AGM, respectively. Among 17 patients with diabetes, median HbA1C was 7% (range 5.7-9.6%). All except one patient had HbA1C< 8%. There was no difference in the GH nadir in patients with or without AGM within G1 (p = 0.15) and G2 (p = 0.43). All G1 patients with AGM had GH nadir > 0.4 µg/L. Four G1 patients with NGM had GH nadir<0.4 µg/L. All G2 patients had GH nadir < 0.4 µg/L, except one with NGM and GH nadir of 0.4 µg/L. CONCLUSION Using highly sensitive GH assay, a GH nadir ≥ 0.4 µg/L during the OGTT-GH suppression test may be used for diagnosis of acromegaly in patients with AGM in the absence of poorly controlled diabetes.
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Affiliation(s)
- Georgiana Dobri
- Department of Neurosurgery Weill Cornell Medicine, New York, NY, 10065, USA.
- Division of Endocrinology, Diabetes and Metabolism Weill Cornell Medicine, New York, NY, 10065, USA.
| | | | - James F Bena
- Department of Quantitative Health Sciences Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Manjula Gupta
- Department of Laboratory Medicine, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - John Kirwan
- Department of Integrated Physiology and Molecular Medicine, Pennington Biomedical Research Center, Baton Rouge, LA, 70808, USA
| | - Lawrence Kennedy
- Department of Endocrinology, Diabetes and Metabolism Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Amir H Hamrahian
- Division of Endocrinology, Diabetes and Metabolism Johns Hopkins University, Baltimore, MD, 21287, USA
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Caputo M, Ucciero A, Mele C, De Marchi L, Magnani C, Cena T, Marzullo P, Barone-Adesi F, Aimaretti G. Use of administrative health databases to estimate incidence and prevalence of acromegaly in Piedmont Region, Italy. J Endocrinol Invest 2019; 42:397-402. [PMID: 30069856 DOI: 10.1007/s40618-018-0928-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 07/25/2018] [Indexed: 11/26/2022]
Abstract
PURPOSE Recent studies from national registries have described changing patterns in epidemiology of acromegaly. Our retrospective study used administrative databases to estimate prevalence and incidence of acromegaly in the Piedmont Region, Italy. METHODS This study was conducted in Piedmont between 2012 and 2016 on administrative health databases for inpatients and outpatients of any age. Enrollees were included if claims suggestive of acromegaly were identified in at least two of the following databases: Drug Claims Registry, Hospital Information System, Co-payment Exemption Registry and Outpatient Specialist Service Information System. RESULTS 369 individuals (M = 146, F = 223) met our criteria. Overall incidence was 5.3 per million person years (95% CI 4.2-6.7), and prevalence was 83 cases per million inhabitants (95% CI 75-92). Mean age was 50.9 years. Both incidence and prevalence were slightly higher among women (rate ratio 1.08, prevalence ratio 1.43). Age-specific incidence was similar between sexes up to 39 years and diverged thereafter, with an increasing trend recorded among men. Prevalence was higher in women aged 40-79 years, and increased continuously up to 79 years in both sexes. CONCLUSIONS This is the first population-based study conducted in Italy to estimate incidence and prevalence of acromegaly and results show a higher prevalence than previously reported. Although our algorithm requires proper validation, it constitutes a promising tool to describe the epidemiology of acromegaly.
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Affiliation(s)
- M Caputo
- Endocrinology, Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
| | - A Ucciero
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
| | - C Mele
- Endocrinology, Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
| | - L De Marchi
- Endocrinology, Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
| | - C Magnani
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
| | - T Cena
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
| | - P Marzullo
- Endocrinology, Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
| | - F Barone-Adesi
- Department of Pharmaceutical Sciences, Università del Piemonte Orientale, Novara, Italy
| | - G Aimaretti
- Endocrinology, Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy.
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Varnava KG, Sarojini V. Making Solid-Phase Peptide Synthesis Greener: A Review of the Literature. Chem Asian J 2019; 14:1088-1097. [PMID: 30681290 DOI: 10.1002/asia.201801807] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 01/24/2019] [Indexed: 11/07/2022]
Abstract
To date, the synthesis of peptides is concurrent with the production of enormous amounts of toxic waste. DMF, CH2 Cl2 , and NMP are three of the most toxic organic solvents used in chemical synthesis and are the most common solvents used for peptide synthesis. Additionally, concerns about the hepatotoxicity caused by exposure to DMF and from the toxic and allergenic nature of additives used in peptide synthesis necessitates the need for a green, environmentally friendly, and safer protocol for peptide synthesis. This review summarizes the current literature on green solid-phase peptide synthesis successes and challenges encountered. The review concludes with suggestions for future research towards a simple and efficient green peptide synthesis protocol.
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Affiliation(s)
- Kyriakos G Varnava
- School of Chemical Sciences, University of Auckland, Auckland, 1142, New Zealand
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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: 185] [Impact Index Per Article: 37.0] [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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Demirpence M, Guler A, Yilmaz H, Sayin A, Pekcevik Y, Turkon H, Colak A, Ari EM, Aslanipour B, Kocabas GU, Calan M. Is elevated urotensin II level a predictor for increased cardiovascular risk in subjects with acromegaly? J Endocrinol Invest 2019; 42:207-215. [PMID: 29804270 DOI: 10.1007/s40618-018-0905-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Accepted: 05/18/2018] [Indexed: 02/07/2023]
Abstract
PURPOSE Acromegaly is a rare disorder existed in the result of overproduction of growth hormone (GH). The disorder is associated with increased cardiovascular risk factors and metabolic abnormalities. Urotensin II (UII), a secreted vasoactive peptide hormone, belonging somatostatin superfamily, plays an essential role in atherosclerosis and glucose metabolism. The aim of this study was to ascertain whether circulating UII levels are altered in subjects with acromegaly, and to describe the relationship between UII and hormonal or cardiometabolic parameters. METHODS This cross-sectional study included 41 subjects with active acromegaly, 28 subjects with controlled acromegaly, and 37 age- and BMI-matched controls without acromegaly. Hormonal and metabolic features of the subjects as well as carotid intima media thickness (cIMT) and epicardial fat thickness (EFT) were defined. Circulation of UII levels was determined via ELISA. RESULTS Both active and controlled acromegalic subjects showed a significant elevation of circulating levels of UII with respect to controls. There was no remarkable difference in circulating levels of UII between active and controlled acromegalic groups. Both cIMT and EFT were remarkably increased in acromegaly subjects comparing to controls. UII positively correlated with cIMT, EFT, BMI, and HOMA-IR. There was no correlation between UII and GH, insulin-like growth factor-1. According to the results obtained from regression models, UII levels independently predicted cIMT and EFT. CONCLUSION Elevated UII levels are associated with severity of cardiovascular risk factors including cIMT and EFT in acromegalic subjects.
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Affiliation(s)
- M Demirpence
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Izmir Tepecik Training and Research Hospital, Tepecik, 35120, Izmir, Turkey
| | - A Guler
- Department of Family Physician, Izmir Bozyaka Training and Research Hospital, Bozyaka, 35170, Izmir, Turkey
| | - H Yilmaz
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Izmir Tepecik Training and Research Hospital, Tepecik, 35120, Izmir, Turkey
| | - A Sayin
- Department of Cardiology, Izmir Tepecik Research and Training Hospital, Tepecik, 35120, Izmir, Turkey
| | - Y Pekcevik
- Department of Radiology, Izmir Tepecik Training and Research Hospital, Tepecik, 35120, Izmir, Turkey
| | - H Turkon
- Department of Medical Biochemistry, Faculty of Medicine, Canakkale Onsekiz Mart University, 17120, Canakkale, Turkey
| | - A Colak
- Department of Clinical Biochemistry, Izmir Tepecik Training and Research Hospital, Tepecik, 35120, Izmir, Turkey
| | - E M Ari
- Department of Clinical Biochemistry, Izmir Tepecik Training and Research Hospital, Tepecik, 35120, Izmir, Turkey
| | - B Aslanipour
- Department of Bioengineering, Faculty of Engineering, Ege University, Bornova, 35100, Izmir, Turkey
| | - G U Kocabas
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Izmir Bozyaka Training and Research Hospital, Bozyaka, 35170, Izmir, Turkey
| | - M Calan
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Izmir Bozyaka Training and Research Hospital, Bozyaka, 35170, Izmir, Turkey.
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Yarman S, Tuncer FN, Serbest E. Three Novel MEN1 Variants in AIP-Negative Familial Isolated Pituitary Adenoma Patients. Pathobiology 2019; 86:128-134. [PMID: 30630164 DOI: 10.1159/000495252] [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: 07/13/2018] [Accepted: 11/01/2018] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES Pituitary adenomas (PAs) may rarely occur in well-defined hereditary conditions, like multiple endocrine neoplasia type 1 (MEN1) syndrome and familial isolated pituitary adenoma (FIPA) associated with germline mutations in MEN1 and AIP, respectively. This study aimed to assess MEN1 genetic abnormalities in AIP mutation-negative FIPA patients, not associated with MEN1 components. METHODS Among 20 patients evaluated in 13 FIPA families, 12 were previously reported as AIP mutation-negative. In this study, 6 new families with 8 patients were recruited. All patients were subjected to multiplex ligation-dependent probe amplification to detect copy number variations in AIP and MEN1, and AIP sequencing was performed in additional patients. AIP mutation-negative patients were subjected to MEN1 sequencing. RESULTS Our cohort revealed only 3 novel heterozygous MEN1 variants including c.1846T>A p.(*616Argext*21), rs778272737:T>C, and rs972128957:C>T in 2 families, with patients diagnosed with Cushing disease, nonfunction al adenoma, and acromegaly, respectively. Among them, c.1846T>A p. (*616Argext*21) is a stop codon read-through, whereas the others are 3'UTR variations. MEN1 variation frequency was detected as 15%. CONCLUSIONS MEN1 alterations can be of significance in FIPA patients and screening could be offered to AIP mutation-negative patients without MEN1 features. Further studies are needed to clarify the role of MEN1 in FIPA patients.
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Affiliation(s)
- Sema Yarman
- Division of Endocrinology and Metabolic Diseases, Department of Internal Medicine, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Feyza Nur Tuncer
- Department of Genetics, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey,
| | - Esin Serbest
- Department of Genetics, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey
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Malaysian Consensus Statement for the Diagnosis and Management of Acromegaly. J ASEAN Fed Endocr Soc 2019; 34:8-14. [PMID: 33442131 PMCID: PMC7784186 DOI: 10.15605/jafes.034.01.03] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 05/14/2019] [Indexed: 12/17/2022] Open
Abstract
In Malaysia, acromegaly is under-recognised with only 10-15% of the expected number of cases from prevalence estimates, having been diagnosed and managed in established endocrine centres with access to multidisciplinary care. This is mainly due to lack of awareness and standardised approach in diagnosing this disease resulting in delay in diagnosis and management with suboptimal treatment outcomes. This first Malaysian consensus statement on the diagnosis and management of acromegaly addresses these issues and is based on current best practices and latest available evidence so as to reduce the disease burden on acromegaly patients managed in the Malaysian healthcare system.
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