A Consensus on Criteria for Cure of Acromegaly

Harvard University, Cambridge, Massachusetts, United States
The Journal of Clinical Endocrinology and Metabolism (Impact Factor: 6.21). 07/2010; 95(7):3141-8. DOI: 10.1210/jc.2009-2670
Source: PubMed


The Acromegaly Consensus Group met in April 2009 to revisit the guidelines on criteria for cure as defined in 2000.
Participants included 74 neurosurgeons and endocrinologists with extensive experience of treating acromegaly. EVIDENCE/CONSENSUS PROCESS: Relevant assays, biochemical measures, clinical outcomes, and definition of disease control were discussed, based on the available published evidence, and the strength of consensus statements was rated.
Criteria to define active acromegaly and disease control were agreed, and several significant changes were made to the 2000 guidelines. Appropriate methods of measuring and achieving disease control were summarized.

17 Reads
  • Source
    • "After surgery, a random GH level < 1 ␮g/l and an IGF-1 level within our age-and sex-adjusted normal range were documented in 7 cases. Oral glucose tolerance testing to check whether GH was suppressible to a nadir of level < 1 ␮g/l was not routinely performed, unfortunately, so that the number (percentage) of patients achieving values defining biochemical remission as proposed by Giustina [5] cannot be given; 1 case (case 1) required further stereotactic radiotherapy. We did not observe any mortality or serious morbidity associated with surgery in these cases. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Objective: To describe an association of growth hormone (GH) secreting pituitary microadenomas and empty sella (ES), which has been described in case reports - the underlying mechanisms are unclear. Methods: We retrospectively analyzed patients operated for GH-producing pituitary adenomas between February 2004 and February 2009. Magnetic resonance imaging (MRI), computed tomography (CT) imaging, and pituitary function testing were performed. All cases underwent transsphenoidal surgery (TSS). Mean follow up was 38 months (range 12-80 months). Results: Out of 152 patients with acromegaly due to GH-producing pituitary adenomas (female:male=73:79; age range 17-63 years), 69 patients had microadenomas (45.4%; 38 females, 31 males). We found 14 cases (14/69, 20.3%), all microadenomas, with presurgical evidence of ES - 10 females (71%) and 4 males (29%) (female:male=2.5:1). When compared with 103 patients with GH-negative microadenomas treated in the same time period (ES in 4 of 103; 3.9%), ES was highly significantly associated with GH production by the microadenoma (p=0.001). In acromegalics with empty sella, no cases of ectopic adenoma were found. Postoperatively, GH and IGF-1 levels fell in all patients, and 7 cases had random GH and IGF-1 levels consistent with cure. Conclusion: The combination of GH-producing microadenomas and empty, enlarged sella is not rare. In this setting, preoperative CT scans are very useful and the transsphenoidal approach is efficient and safe. The mechanism underlying the association of GH-producing microadenomas and empty sella remains unclear and requires further studies.
    Clinical Neurology and Neurosurgery 08/2014; 126C:18-23. DOI:10.1016/j.clineuro.2014.08.012 · 1.13 Impact Factor
  • Source
    • "Biochemical control has been shown to provide improvements in several comorbidities of acromegaly, especially cardiomyopathy, sleep apnea, and arthralgia, but also hypertension and dyslipidemia [3, 42, 43]. In one study involving 30 patients with newly diagnosed acromegaly, 12 months of SSA therapy decreased joint thickness in all cases, but the reduction was greater in those with controlled disease, among whom 61 % had normalization of shoulder thickening and 89 % had normalization of knee thickening [33]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: The current article provides a brief overview of the criteria for defining disease control in acromegaly. This was a retrospective, narrative review of previously published evidence chosen at the author's discretion along with an illustrative case study from Latin America. In the strictest sense, "cure" in acromegaly is defined as complete restoration of normal pulsatile growth hormone secretion, although this is rarely achieved. Rather than "cure", as such, it is more appropriate to refer to disease control and remission, which is defined mainly in terms of specific biochemical targets (for growth hormone and insulin-like growth factor-1) that predict or correlate with symptoms, comorbidities and mortality. However, optimal management of acromegaly goes beyond biochemical control to include control of tumour growth (which may be independent of biochemical control) and comprehensive management of the symptoms and comorbidities typically associated with the disease, as these may not be adequately managed with acromegaly-specific therapy alone.
    Pituitary 11/2013; 17(Suppl 1). DOI:10.1007/s11102-013-0536-7 · 3.20 Impact Factor
  • Source
    • "The study involved 26 subjects with acromegaly (age >18 years) who were followed up at the Clementino Fraga Filho University Hospital of the Federal University of Rio de Janeiro. Diagnoses were based on clinical features and were confirmed by high levels of GH that did not fall below 0.4 ng/mL after an oral glucose tolerance test or IGF-I levels above the upper limit of the age-specific normal range [19,20]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Despite the gradual improvement in treatment procedures and cure rates of acromegaly, a steady increase in the mortality rate due to respiratory disease has been documented in recent decades. In this study, our objectives were to describe the abnormalities in lung structure and function that occur in acromegalic patients and to correlate these changes with hormonal levels. This cross-sectional study included 20 acromegalic patients and 20 age-and height-matched control subjects, all non-smokers. All subjects underwent spirometry, whole body plethysmography, carbon monoxide diffusing capacity, and respiratory muscle strength. Acromegalic patients also performed high-resolution computed tomography (HRCT). Most patients were female (65%), with a mean age of 52.5 +/- 13 years. Acromegalic patients showed lower values of maximum expiratory pressure (55.9 +/- 17.1 vs. 103.7 +/- 19.2%; p < 0.001) and maximum inspiratory pressure (71.4 +/- 27.8 vs. 85.3 +/- 24.1%; p = 0.005) compared to control subjects. The values of forced vital capacity (107.1 +/- 15.9 vs. 98.9 +/- 21.4%; p = 0.028), total lung capacity -- TLC (107.3 +/- 12.9 vs. 93.7 +/- 7.60%; p = 0.002), residual volume (114.1 +/- 22.7 vs. 90.0 +/- 14.6%; p < 0.001), and airways' resistance (3.82 vs. 2.31 cmH2O/L/s; p = 0.039) were greater in acromegalic patients than in control subjects. The difference between the TLC measured by plethysmography and the VA (alveolar volume) measured during the DLCO maneuver was higher in acromegalic patients than in control subjects (0.69 +/- 0.46 vs. 0.19 +/- 0.61 L; p = 0.021). The main findings in HRCT in acromegalic patients were air trapping, airway calcification and bronchiectasis, which were observed in 60%, 40% and 35% of cases, respectively. There was no significant correlation between the levels of growth hormone and insulin-like growth factor I, the lung function and the air trapping. Acromegalic patients show changes consistent with the involvement of the small airways and ventilation inhomogeneity, both in terms of lung function and structure. However, air trapping cannot be explained either by hormone levels or changes in lung function.
    Multidisciplinary respiratory medicine 11/2013; 8(1):70. DOI:10.1186/2049-6958-8-70 · 0.15 Impact Factor
Show more


17 Reads
Available from