Article

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

ABSTRACT

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.

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    • "In the octreotide-group, 6 patients were treated with a monthly dose of 20 mg, 5 with 30 mg, 2 with 10 mg and 1 with 40 mg; in the lanreotide-group, 4 patients were treated with a monthly dose of 120 mg, 2 with 90 mg and 1 with 60 mg of ATG. The activity of disease at the time of the study was confirmed by plasma mean GH profile, elevated age-and gender-corrected plasma IGF-1 levels and nonsuppressible GH after OGTT [12]. According to these criteria, all patients were grouped into those with uncontrolled (group A: 33 patients, including 16 ND, 10 SA, 5 PE, 2 SU) and controlled (group B: 23 patients, including 11 SA, 7 PE, 5 SU) disease. "
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    • "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. "
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