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.

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    ABSTRACT: The studies that have extensively evaluated the relation between adipokines and metabolic parameters in acromegaly treatment are quite discordant. We aimed to evaluate and correlate a set of selected adipokines, known to have a metabolic role, with the disease activity, metabolic status and treatment modalities. Data of 56 consecutive acromegalic patients (31 M and 25 F; aged 54±12years), admitted to the section of Endocrinology of the University of Palermo during the years 2005-2014, including 16 newly diagnosed untreated (ND), 21 during therapy with somatostatin analogues (SA), 12 with pegvisomant (PE) and 7 after surgical treatment (SU), grouped into uncontrolled (group A: No. 33) and controlled (group B: No. 23) were evaluated. Anthropometric and metabolic parameters, insulin sensitivity indexes, visceral adiposity index (VAI), leptin, soluble leptin receptor, adiponectin, visfatin, resistin, adipsin and non-esterified fatty acids (NEFAs) were assessed. In a subgroup of 21 subjects, the insulin sensitivity index (M value) derived from euglycemic clamp was calculated. Group A showed higher Homa-IR (p<0.001), VAI (p<0.001), triglycerides (p<0.001), visfatin (p<0.001), and NEFAs (p<0.001) and lower ISI Matsuda (p<0.001), M value (p<0.001), HDL cholesterol (p<0.001) and leptin (p<0.001) than group B. ND patients showed higher VAI, triglycerides, Homa-IR, and visfatin and lower ISI Matsuda, M-value, and leptin compared to other groups (all p<0.050), while no differences were found among SA, PE and SU patients. IGF-1 (p=0.048), M-value (p=0.0029) and VAI (p=0.010) were independently associated with visfatin, while only ISI Matsuda (p=0.019) was associated with leptin. In acromegaly visfatin could be considered a useful index of disease activity and metabolic alterations, such as insulin resistance and adipose dysfunction, regardless of the type of treatment. Copyright © 2015 Elsevier Ltd. All rights reserved.
    Full-text · Article · Jul 2015 · Growth hormone & IGF research: official journal of the Growth Hormone Research Society and the International IGF Research Society
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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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    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.
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    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.
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