A Consensus on Criteria for Cure of Acromegaly

ArticleinThe Journal of Clinical Endocrinology and Metabolism 95(7):3141-8 · July 2010with21 Reads
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.
    • "The goals of therapy are to control the levels of both GH and insulin-like growth factor 1 (IGF-1), reduce and/or stabilize tumor size, preserve pituitary function and prevent recurrence. A recent consensus statement on the management of acromegaly advocates reducing GH and IGF-1 levels to as close to normal as possible (GH <1.0 μg/L [using an ultrasensitive assay] and IGF-1 within the normal range for age and sex) [3, 4]. Earlier studies measuring GH by radioimmunoassay indicated that suppression of random GH to <2.5 μg/L and normalization of IGF-1 levels are associated with restoration of mortality to that of a standard population [5]. "
    [Show abstract] [Hide abstract] ABSTRACT: Background: Many patients with acromegaly do not achieve biochemical control with first-generation somatostatin analogues. A large, multicenter, randomized, Phase III core study demonstrated that pasireotide LAR had significantly superior efficacy over octreotide LAR. This analysis explores the efficacy and safety of switching therapeutic arms in inadequately controlled patients during a 12-month crossover extension. Methods: Patients with inadequate biochemical control (GH ≥2.5 μg/L and/or IGF-1 > ULN) at end of core study (month 12) were eligible to switch to pasireotide LAR 40 mg/28 days (n = 81) or octreotide LAR 20 mg/28 days (n = 38). One dose escalation to pasireotide LAR 60 mg/28 days or octreotide LAR 30 mg/28 days was permitted, but not mandatory, at month 17 or 20. Results: Twelve months after crossover, 17.3 % of pasireotide LAR and 0 % of octreotide LAR patients achieved GH <2.5 μg/L and normal IGF-1 (main outcome measure); 27.2 and 5.3 % of pasireotide LAR and octreotide LAR patients achieved normal IGF-1, respectively; 44.4 and 23.7 % of pasireotide LAR and octreotide LAR patients achieved GH <2.5 μg/L, respectively. Mean (±SD) tumor volume further decreased from the end of the core study by 25 % (±25) and 18 % (±28); 54.3 % of pasireotide LAR and 42.3 % of octreotide LAR patients achieved significant (≥20 %) tumor volume reduction during the extension. The safety profile of pasireotide LAR was similar to that of octreotide LAR, with the exception of the frequency and degree of hyperglycemia-related adverse events. Conclusions: Pasireotide LAR is a promising treatment option for patients with acromegaly inadequately controlled with the first-generation somatostatin analogue octreotide LAR. Trial registration: clinicaltrials.gov, NCT00600886 . Registered 14 January 2008.
    Full-text · Article · Dec 2016
    • "Volume 3 Issue 3 -2016 though different criteria for a cure have been suggested, the relationship between these criteria and long term disease control is not well known [18][19][20][21][22][23][24][25][26]. The purpose of this is study is to validate the relationship between the early postoperative basal GH level and long term GH level (or in other words, based on GH level early postoperative, what are the chances that the GH will be normalized in long term). "
    Article · Sep 2016
    • "Cure of acromegaly after pituitary surgery was defined as when serum IGF‑1 levels were within the normal age‑ and sex‑matched range and serum GH was suppressed <1 ng/ml at 1 h after 75 g glucose as used in international consensus. [19] "
    [Show abstract] [Hide abstract] ABSTRACT: Background: There are conflicting data regarding the prevalence of colorectal polyp in patients with acromegaly. Subjects and Methods: Consecutive forty-seven acromegalic patients (21 men, 26 women), with a mean age of (40 ± 12 years) attending endocrinology outpatient department underwent full colonoscopy. All the patients underwent clinical and biochemical evaluation (glucose suppressed growth hormone (GH), Insulin-like growth factor-1 [IGF-1], fasting insulin, and glucose). The control group (n = 120) for colonoscopy was adult subjects undergoing evaluation for symptoms of irritable bowel syndrome. Clinical and biochemical parameters in acromegalic patients with colonic polyp were compared to those without a polyp. Results: Patients with acromegaly had significantly higher prevalence of colonic polyp as compared to control subjects (10.6% vs. 0.8%). None of the patients with polyp had skin tags. There was no significant difference between subjects with and without colonic polyp in duration of illness, basal, and glucose-suppressed GH and most recent IGF-1. Fasting blood sugar was significantly higher (P < 0.05) in adenoma group after adjusting for age, body mass index (BMI), and insulin levels. Patients in adenoma group showed a trend toward male gender and younger age as compared to those without adenoma. Conclusions: Subjects with acromegaly as compared to control have a higher prevalence of colonic polyps. There was no association of polyps seen with age, BMI, skin tags, homeostasis model assessment of insulin resistance index, duration of disease, and basal and glucose-suppressed GH and IGF-1 levels. There were no specific predictive factors detected. Screening full colonoscopy is recommended in all cases with acromegaly.
    Full-text · Article · Jul 2016
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