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Rosendal C, Arlien-Søborg MC, Nielsen EH, Andersen MS, Feltoft CL, Kistorp C, Dekkers OM, Jørgensen JOL, Dal J. The changing landscape of acromegaly - an epidemiological perspective. Rev Endocr Metab Disord 2024:10.1007/s11154-024-09875-z. [PMID: 38337125 DOI: 10.1007/s11154-024-09875-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/12/2024] [Indexed: 02/12/2024]
Abstract
Acromegaly is a rare disease and thus challenging to accurately quantify epidemiologically. In this comprehensive literature review, we compare different approaches to studying acromegaly from an epidemiological perspective and describe the temporal evolution of the disease pertaining to epidemiological variables, clinical presentation and mortality. We present updated epidemiological data from the population-based Danish cohort of patients with acromegaly (AcroDEN), along with meta-analyses of existing estimates from around the world.Based on this, we conclude that the incidence, prevalence and age at acromegaly diagnosis are all steadily increasing, but with considerable variation between studies. An increased number of incidental cases may contribute to the increase in incidence and age at diagnosis, respectively. The clinical features at presentation are trending toward a milder disease phenotype at diagnosis, and advances in therapeutic options have reduced the mortality of patients with acromegaly to a level similar to that of the general population. Moreover, the underlying cause of death has shifted from cardiovascular to malignant neoplastic diseases.
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Affiliation(s)
- Christian Rosendal
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark.
| | | | | | | | - Claus Larsen Feltoft
- Department of Medicine, Copenhagen University Hospital - Herlev and Gentofte Hospital, Herlev, Denmark
| | - Caroline Kistorp
- Department of Hormone and Metabolism, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Olaf M Dekkers
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Endocrinology, Leiden University Medical Center, Leiden, The Netherlands
- Aarhus KEA, Aarhus University Hospital, Aarhus, Denmark
| | | | - Jakob Dal
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
- Steno Diabetes Center North Jutland, Aalborg, Denmark
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Karsy M, Kshettry V, Gardner P, Chicoine M, Fernandez-Miranda JC, Evans JJ, Barkhoudarian G, Hardesty D, Kim W, Zada G, Crocker T, Torok I, Little A. The RAPID Consortium: A Platform for Clinical and Translational Pituitary Tumor Research. J Neurol Surg B Skull Base 2024; 85:1-8. [PMID: 38274483 PMCID: PMC10807961 DOI: 10.1055/a-1978-9380] [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: 07/10/2022] [Accepted: 09/07/2022] [Indexed: 11/17/2022] Open
Abstract
Objectives Pituitary tumor treatment is hampered by the relative rarity of the disease, absence of a multicenter collaborative platform, and limited translational-clinical research partnerships. Prior studies offer limited insight into the formation of a multicenter consortium. Design The authors describe the establishment of a multicenter research initiative, Registry of Adenomas of the Pituitary and Related Disorders (RAPID), to encourage quality improvement and research, promote scholarship, and apply innovative solutions in outcomes research. Methods The challenges encountered during the formation of other research registries were reviewed with those lessons applied to the development of RAPID. Setting/Participants RAPID was formed by 11 academic U.S. pituitary centers. Results A Steering Committee, bylaws, data coordination center, and leadership team have been established. Clinical modules with standardized data fields for nonfunctioning adenoma, prolactinoma, acromegaly, Cushing's disease, craniopharyngioma, and Rathke's cleft cyst were created using a Health Insurance Portability and Accountability Act-compliant cloud-based platform. Currently, RAPID has received institutional review board approval at all centers, compiled retrospective data and agreements from most centers, and begun prospective data collection at one site. Existing institutional databases are being mapped to one central repository. Conclusion The RAPID consortium has laid the foundation for a multicenter collaboration to facilitate pituitary tumor and surgical research. We sought to share our experiences so that other groups also contemplating this approach may benefit. Future studies may include outcomes benchmarking, clinically annotated biobank tissue, multicenter outcomes studies, prospective intervention studies, translational research, and health economics studies focused on value-based care questions.
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Affiliation(s)
- Michael Karsy
- Department of Neurosurgery, The University of Utah, Salt Lake City, Utah, United States
| | - Varun Kshettry
- Department of Neurosurgery, Cleveland Clinic, Cleveland, Ohio, United States
| | - Paul Gardner
- Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Michael Chicoine
- Department of Neurosurgery, Washington University in Saint Louis, Saint Louis, Missouri, United States
| | - Juan C. Fernandez-Miranda
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - James J. Evans
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, United States
| | - Garni Barkhoudarian
- Department of Neurosurgery, Pacific Neuroscience Institute, Los Angeles, California, United States
| | - Douglas Hardesty
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
| | - Won Kim
- Department of Neurosurgery, University of California, Los Angeles (UCLA), Los Angeles, California, United States
| | - Gabriel Zada
- Department of Neurosurgery, University of Southern California, Los Angeles, California, United States
| | - Tomiko Crocker
- Barrow Clinical Outcomes Center, Barrow Neurological Institute, Phoenix, Arizona, United States
| | - Ildiko Torok
- Barrow Clinical Outcomes Center, Barrow Neurological Institute, Phoenix, Arizona, United States
| | - Andrew Little
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, United States
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Kerbel J, Cano-Zaragoza A, Espinosa-Dorado R, García de la Torre KE, Mercado M. Real World Data on the Epidemiology, Diagnosis, and Treatment of Acromegaly: A Registries-based Approach. Arch Med Res 2023; 54:102856. [PMID: 37481822 DOI: 10.1016/j.arcmed.2023.102856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 07/05/2023] [Accepted: 07/11/2023] [Indexed: 07/25/2023]
Abstract
INTRODUCTION Despite the inherent heterogeneity of the information derived from national registries, they are a useful tool to investigate the epidemiological, clinical, biochemical and treatment outcome characteristics of low prevalence conditions such as acromegaly. Although the information provided by single-center experiences is more homogeneous, these studies usually comprise a limited number of patients and thus, frequently lack statistical power. AREAS COVERED Registry-based Information regarding the epidemiology, clinical presentation, biochemical and imaging diagnosis, as well as therapeutic outcome and mortality in acromegaly is critically analyzed. EXPERT OPINION By gathering data from multiple centers in a specific Country, these registries generate important insights into the real-life behavior of this condition, that should be considered, both, in international consensus meetings and in the design of local, Country-specific diagnostic and therapeutic strategies.
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Affiliation(s)
- Jacobo Kerbel
- Endocrine Research Unit, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Amayrani Cano-Zaragoza
- Endocrine Research Unit, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Rodrigo Espinosa-Dorado
- Endocrine Research Unit, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Keren-Enid García de la Torre
- Endocrine Research Unit, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Moisés Mercado
- Endocrine Research Unit, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico.
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Hageman IC, van Rooij IALM, de Blaauw I, Trajanovska M, King SK. A systematic overview of rare disease patient registries: challenges in design, quality management, and maintenance. Orphanet J Rare Dis 2023; 18:106. [PMID: 37147718 PMCID: PMC10163740 DOI: 10.1186/s13023-023-02719-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 05/01/2023] [Indexed: 05/07/2023] Open
Abstract
Patient registries serve to overcome the research limitations inherent in the study of rare diseases, where patient numbers are typically small. Despite the value of real-world data collected through registries, adequate design and maintenance are integral to data quality. We aimed to describe an overview of the challenges in design, quality management, and maintenance of rare disease registries.A systematic search of English articles was conducted in PubMed, Ovid Medline/Embase, and Cochrane Library. Search terms included "rare diseases, patient registries, common data elements, quality, hospital information systems, and datasets". Inclusion criteria were any manuscript type focused upon rare disease patient registries describing design, quality monitoring or maintenance. Biobanks and drug surveillances were excluded.A total of 37 articles, published between 2001 and 2021, met the inclusion criteria. Patient registries covered a wide range of disease areas and covered multiple geographical locations, with a predisposition for Europe. Most articles were methodological reports and described the design and setup of a registry. Most registries recruited clinical patients (92%) with informed consent (81%) and protected the collected data (76%). Whilst the majority (57%) collected patient-reported outcome measures, only few (38%) consulted PAGs during the registry design process. Few reports described details regarding quality management (51%) and maintenance (46%).Rare disease patient registries are valuable for research and evaluation of clinical care, and an increasing number have emerged. However, registries need to be continuously evaluated for data quality and long-term sustainability to remain relevant for future use.
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Affiliation(s)
- Isabel C Hageman
- Department for Surgery, Pediatric Surgery, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, The Netherlands.
- Surgical Research, Murdoch Children's Research Institute, Melbourne, Australia.
| | - Iris A L M van Rooij
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ivo de Blaauw
- Department for Surgery, Pediatric Surgery, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Misel Trajanovska
- Surgical Research, Murdoch Children's Research Institute, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Sebastian K King
- Surgical Research, Murdoch Children's Research Institute, Melbourne, Australia
- Department of Paediatric Surgery, The Royal Children's Hospital, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
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Tönjes A, Quinkler M, Knappe U, Störmann S, Schöfl C, Schopohl J, Meyhöfer SM. [Treatment of acromegaly - data from the German Acromegaly Register]. Dtsch Med Wochenschr 2023; 148:380-385. [PMID: 36940688 DOI: 10.1055/a-1847-2553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
Acromegaly is a rare disease in which chronic growth hormone overproduction (usually from an anterior pituitary adenoma) leads to various systemic complications. The management of acromegaly and the comorbidities of the disease is complex and requires a multidisciplinary approach. Early diagnosis is extremely important, as then the chances of a complete cure are significantly higher. The operation is the therapy of first choice and should be performed at a specialized center with an experienced neurosurgeon. With good patient information and guidance, the drug therapy of acromegaly patients in specialized practices and clinics can usually lead to biochemical control and thereby normalization of mortality risk. As with numerous rare diseases, care in specialized centers and recording and evaluation in registry studies can contribute to better patient care and the optimization of therapy and diagnostic guidelines. We assume that with the help of the German Acromegaly Registry, which currently includes more than 2500 patients with acromegaly, we will be able to present a realistic picture of the care situation in Germany in the coming years.
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Castellanos-Bueno R, Abreu-Lomba A, Buitrago-Gómez N, Patiño-Arboleda M, Pantoja-Guerrero D, Valenzuela-Rincón A, Arenas-Quintero HM, Franco-Betancur HI, Castellanos-Pinedo A, Movilla-Castro D, Ocampo-Chaparro JM, Reyes-Ortiz CA, Pinzón-Tovar A. Clinical and epidemiological characteristics, morbidity and treatment based on the registry of acromegalic patients in Colombia: RAPACO. Growth Horm IGF Res 2021; 60-61:101425. [PMID: 34416544 DOI: 10.1016/j.ghir.2021.101425] [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: 04/09/2021] [Revised: 08/07/2021] [Accepted: 08/09/2021] [Indexed: 10/20/2022]
Abstract
AIMS Describe the local characteristics, methodology and results of the registry of acromegalic patients in Colombia (RAPACO). METHODS Multicenter, retrospective study based on the registry of acromegalic patients in Colombia: RAPACO. The data collected included: demographics, diagnosis, approximate time of disease evolution, data on weight, height, body mass index (BMI), neck circumference (NC) abdominal circumference (AC) hip circumference (HC) and waist/hip ratio (WHR); clinical and biochemical data at the time of diagnosis, etiology, immunohistochemistry of the tumor and information related to types of treatment. Descriptive analytics were employed. RESULTS A total of 201 patients (60% females) with an average age at registration of 49.5 ± 14.6 years and an average time of evolution of the disease of 6.96 ± 4.5 years. Average weight was 75.1 Kg ± 12.98, with an average BMI of 28.11 ± 4.33. The most frequent symptoms mentioned at the time of diagnosis were extremity enlargement and headache. The most frequent comorbidity was arterial hypertension in 50.3% of the cases. 78.6% of cases were caused by macroadenoma. 80.1% received surgical treatment, 77.6% were under medical treatment, of which 95.7% were receiving somatostatin analogues. 26.4% of patients were treated with radiation therapy. Of the patients who received any type of clinical treatment, only 2.5% reported biochemical control at registration. CONCLUSION It is important to recognize the local epidemiological, clinical, biochemical and treatment characteristics in order to assist in further understanding this pathology to implement local measures to improve both the quality of life as well as the prognosis of the patients diagnosed.
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Affiliation(s)
| | - Alín Abreu-Lomba
- Universidad Libre, Cali - Colombia, GIMI1 (Grupo interinstitucional de Medicina Interna 1), Department of Endocrinology, Clínica Imbanaco grupo QuironSalud, Cali, Colombia; Universidad Libre, GIMI1 (Grupo interinstitucional de Medicina Interna 1), Department of Internal Medicine, Cali, Colombia.
| | - Nathalia Buitrago-Gómez
- Universidad Libre, GIMI1 (Grupo interinstitucional de Medicina Interna 1), Department of Internal Medicine, Cali, Colombia.
| | - Marcela Patiño-Arboleda
- Universidad Libre, GIMI1 (Grupo interinstitucional de Medicina Interna 1), Department of Internal Medicine, Cali, Colombia.
| | | | - Alex Valenzuela-Rincón
- Universidad del Rosario Bogotá, Department of Endocrinology Fundación Cardioinfantil, Colombia.
| | - Henry M Arenas-Quintero
- Universidad tecnológica de Pereira, Department of Endocrinology Clínica Comfamiliar Pereira, Colombia.
| | | | - Alejandro Castellanos-Pinedo
- Universidad del Sinú, Monteria, Colombia, Department of Endocrinology Hospital San Jerónimo, Montería, Colombia.
| | | | - José M Ocampo-Chaparro
- Universidad Libre, GIMI1 (Grupo interinstitucional de Medicina Interna 1), Department of Internal Medicine, Cali, Colombia; Universidad del Valle, Facultad de Salud, Departamento Medicina Familiar, Cali, Colombia.
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7
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Dal J, Skov BG, Andersen M, Feldt-Rasmussen U, Feltoft CL, Karmisholt J, Nielsen EH, Dekkers OM, Jørgensen JOL. Sex differences in acromegaly at diagnosis: A nationwide cohort study and meta-analysis of the literature. Clin Endocrinol (Oxf) 2021; 94:625-635. [PMID: 33306249 DOI: 10.1111/cen.14392] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 11/06/2020] [Accepted: 12/03/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Data on sex differences in acromegaly at the time of diagnosis vary considerably between studies. DESIGN A nationwide cohort study including all incident cases of acromegaly (1978-2010, n = 596) and a meta-analysis on sex differences in active acromegaly (40 studies) were performed. METHOD Sex-dependent differences in prevalence, age at diagnosis, diagnostic delay, pituitary adenoma size, insulin-like growth factor 1 (IGF-I) and growth hormone (GH) concentrations were estimated. RESULTS The cohort study identified a balanced gender distribution (49.6% females) and a comparable age (years) at diagnosis (48.2 CI95% 46.5-49.8 (males) vs. 47.2 CI95% 45.5-48.9 (females), p = 0.4). The incidence rate significantly increased during the study period (R2 = 0.42, p < 0.01) and the gender ratio (F/M) changed from female predominance to an even ratio (SR: 1.4 vs. 0.9, p = 0.03). IGF-ISDS was significantly lower in females compared to males, whereas neither nadir GH nor pituitary adenoma size differed between males and females. In the meta-analysis, the weighted percentage female was 53.3% (CI95% 51.5-55.2) with considerable heterogeneity (I2 = 85%) among the studies. The mean age difference at diagnosis between genders was 3.1 years (CI95% 1.9-4.4), and the diagnostic delay was longer in females by 0.9 years (CI95% -0.4 to 2.1). Serum IGF-I levels were significantly lower in female patients, whereas nadir GH, and pituitary adenoma size were comparable. CONCLUSION There are only a minor sex differences in the epidemiology of acromegaly at the time of diagnosis except that female patients are slightly older and exhibit lower IGF-I concentrations and a longer diagnostic delay.
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Affiliation(s)
- Jakob Dal
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
- Steno Diabetes Center North Jutland, Aalborg, Denmark
| | - Benedikte G Skov
- Department of Endocrinology, Aarhus University Hospital, Aarhus C, Denmark
| | - Marianne Andersen
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
| | - Ulla Feldt-Rasmussen
- Department of Endocrinology and Metabolism, National University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Claus L Feltoft
- Department of Endocrinology, Herlev University Hospital, Herlev, Denmark
| | - Jesper Karmisholt
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
- Clinical Institute, Aalborg University, Aalborg, Denmark
| | - Eigil H Nielsen
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
| | - Olaf M Dekkers
- Department of Clinical Epidemiolgy and Metabolism, Leiden University Medical Centre, Leiden, The Netherlands
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Antsiferov MB, Pronin VS, Alekseeva TM, Ionova OA, Martynova EY, Poteshkin YE, Chubrova NA, Zherebchikova KY. [Selective screening of patients with associated somatic diseases as a method of early detection of acromegaly]. ACTA ACUST UNITED AC 2021; 67:20-30. [PMID: 33586389 PMCID: PMC8926112 DOI: 10.14341/probl12699] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 12/14/2020] [Accepted: 01/01/2021] [Indexed: 01/10/2023]
Abstract
Backgraund Backgraund: Acromegaly is a multi-organ disabling disease, the effectiveness of treatment of which directly depends on timely diagnosis. Latent course and delayed diagnosis increase the exposure of pathological hypersecretion of growth hormone and insulin-like growth factor-1, contributing to the development of irreversible systemic and metabolic changes in the body that negatively affect survival. Aims Aims: The aim of the study was to clinically test a comprehensive diagnostic approach using selective screening to detect cases of acromegaly in patients with combined somatic diseases. Materials and methods Materials and methods: The diagnostic search algorithm included a 2-stage questionnaire, expert assessment of the clinical status, laboratory and instrumental examination. The inpatient examination included the use of additional laboratory and instrumental methods and expert evaluation of the results obtained by filling out a doctor’s questionnaire. When the score was higher than 18 points, a more specific examination was performed: double determination of the insulin-like growth factor-1 level, oral glucose tolerance test with determination of the nadir of growth hormone value, and MRI of the brain with contrast enhancement. The diagnosis of acromegaly was made on the basis of personal data, expert assessment of the clinical status, results of laboratory and instrumental examinations. Results Results: A survey of 1249 patients with combined systemic and metabolic disorders conducted using the point system allowed us to suspect acromegaly in 367 patients (29.4%), who were offered further examination. The majority of patients were previously seen by specialists for diabetes mellitus (79.3%) or thyroid pathology (10%). In the result of inpatient examination of 329 patients, 35 (10.6%) patients showed an increase in the blood level of IGF-I. In 19 patients, a persistent increase in the level of IGF-I was combined with the absence of GH suppression of less than 0.4 ng/ml against the background of glucose load. During MRI in 9 patients, pituitary adenoma was detected (in 2 — microadenoma and 7 — macroadenoma). Conclusions Conclusions: As a result of the study, among the group of 1249 patients (mean age 58±13 years) with the presence of concomitant diseases, 9 newly identified patients with acromegaly were found who were prescribed adequate treatment. The introduction of selective screening technology into the practice of an endocrinologist will improve the effectiveness of diagnostic search for patients with acromegaly, more accurately assess the prevalence of the disease in Russia and the need for specialized medical care.
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Affiliation(s)
- M B Antsiferov
- Endocrinological dispensary of Moscow Healthcare Department
| | - V S Pronin
- Russian medical Academy of continuing professional education
| | - T M Alekseeva
- Endocrinological dispensary of Moscow Healthcare Department
| | - O A Ionova
- Endocrinological dispensary of Moscow Healthcare Department
| | | | - Yu E Poteshkin
- Pirogov Russian National Research Medical University (Pirogov Medical University)
| | - N A Chubrova
- Moscow state medical University named after I.M. Sechenov (Sechenov University)
| | - K Y Zherebchikova
- Moscow state medical University named after I.M. Sechenov (Sechenov University)
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Ku CR, Melnikov V, Zhang Z, Lee EJ. Precision Therapy in Acromegaly Caused by Pituitary Tumors: How Close Is It to Reality? Endocrinol Metab (Seoul) 2020; 35:206-216. [PMID: 32615705 PMCID: PMC7386101 DOI: 10.3803/enm.2020.35.2.206] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 06/01/2020] [Indexed: 01/25/2023] Open
Abstract
Acromegaly presents with an enigmatic range of symptoms and comorbidities caused by chronic and progressive growth hormone elevations, commonly due to endocrinologic hypersecretion from a pituitary gland tumor. Comprehensive national acromegaly databases have been appearing over the years, allowing for international comparisons of data, although still presenting varying prevalence and incidence rates. Lack of large-scale analysis in geographical and ethnic differences in clinical presentation and management requires further research. Assessment of current and novel predictors of responsiveness to distinct therapy can lead to multilevel categorization of patients, allowing integration into new clinical guidelines and reduction of increased morbidity and mortality associated with acromegaly. This review compares current data from epidemiological studies and assesses the present-day application of prognostic factors in medical practice, the reality of precision therapy, as well as its future prospects in acromegaly, with a special focus on its relevance to the South Korean population.
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Affiliation(s)
- Cheol Ryong Ku
- Division of Endocrinology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul,
Korea
| | - Vladimir Melnikov
- Department of Endocrinology and Metabolism, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai,
China
| | - Zhaoyun Zhang
- Department of Endocrinology and Metabolism, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai,
China
| | - Eun Jig Lee
- Division of Endocrinology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul,
Korea
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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: 21] [Impact Index Per Article: 4.2] [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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Heinrich DA, Reinholz C, Bauer M, Tufman A, Frohner R, Schopohl J, Bidlingmaier M, Kosilek RP, Reincke M, Schneider HJ. IGF-1-based screening reveals a low prevalence of acromegaly in patients with obstructive sleep apnea. Endocrine 2018; 60:317-322. [PMID: 29388045 DOI: 10.1007/s12020-018-1538-z] [Citation(s) in RCA: 6] [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: 10/27/2017] [Accepted: 01/15/2018] [Indexed: 01/21/2023]
Abstract
PURPOSE Recent epidemiologic studies suggest a high prevalence of acromegaly. The prevalence of obstructive sleep apnea syndrome (OSAS) in acromegaly patients ranges from 47 to 70%. A recent study identified 2 patients with acromegaly among 567 OSAS patients. However, it remains unclear whether screening for acromegaly among OSAS patients is necessary. The aim was to screen for acromegaly among OSAS patients by measuring IGF-1 levels and performing confirmatory tests if necessary. METHODS We performed a prospective cross-sectional diagnostic study on the prevalence of acromegaly in patients with OSAS. A total of 507 patients with a confirmed diagnosis of OSAS (357 male, 150 female) were screened. RESULTS Seven male and three female patients (1.97% of total) were positively screened for elevated IGF-1 levels. Nine out of ten patients suppressed growth hormone levels during OGTT excluding acromegaly, whereas one individual was identified to have acromegaly according to established criteria (1/507, prevalence 0.2%). Analysis of the data showed no correlation between elevated IGF-1 values and the severity of OSAS or BMI. CONCLUSIONS Our data demonstrate a low prevalence of acromegaly in patients with OSAS. Until data from population-based studies is available we suggest restricting screening for acromegaly in OSAS to those patients who have additional clinical features of acromegaly.
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Affiliation(s)
- Daniel A Heinrich
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Ziemssenstraße 1, 80331, München, Germany.
| | - Claudia Reinholz
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Ziemssenstraße 1, 80331, München, Germany
| | - Maximilian Bauer
- Asklepios Fachkliniken München-Gauting, Lehrklinik der LMU München, Robert-Koch-Allee 2, 82131, Gauting, Germany
| | - Amanda Tufman
- Asklepios Fachkliniken München-Gauting, Lehrklinik der LMU München, Robert-Koch-Allee 2, 82131, Gauting, Germany
- Medizinische Klinik und Poliklinik V, Klinikum der Universität München, Ziemssenstraße 1, 80331, München, Germany
| | - Richard Frohner
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Ziemssenstraße 1, 80331, München, Germany
| | - Jochen Schopohl
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Ziemssenstraße 1, 80331, München, Germany
| | - Martin Bidlingmaier
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Ziemssenstraße 1, 80331, München, Germany
| | - Robert P Kosilek
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Ziemssenstraße 1, 80331, München, Germany
| | - Martin Reincke
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Ziemssenstraße 1, 80331, München, Germany
| | - Harald J Schneider
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Ziemssenstraße 1, 80331, München, Germany
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12
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Schöfl C, Petroff D, Tönjes A, Grussendorf M, Droste M, Stalla G, Jaursch-Hancke C, Störmann S, Schopohl J. Incidence of myocardial infarction and stroke in acromegaly patients: results from the German Acromegaly Registry. Pituitary 2017; 20:635-642. [PMID: 28808855 DOI: 10.1007/s11102-017-0827-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE Acromegaly is a rare disease generally brought about by a benign tumour in the pituitary and characterized by growth hormone (GH) and insulin-like growth factor 1 (IGF-1) excess. Increased mortality has been related to cardiovascular events that could be linked to these hormones and patients suffer from high rates of diabetes and hypertension. In this study, we examine if the incidence of myocardial infarction (MI) and stroke differ from that of the general population. METHODS Data from the German Acromegaly Registry in seven specialized endocrine centres were analysed (n = 479, 56% female, 46 years old at diagnosis, 5549 person-years from diagnosis). Standardized incidence ratios (SIR) were calculated as compared to the general population. RESULTS MI and stroke incidences were very close to those of the general population with an SIR (95% CI) of 0.89 (0.47-1.52, p = 0.80) for MI and 1.17 (0.66-1.93, p = 0.61) for stroke. Acromegaly was uncontrolled in 16% of patients with MI or stroke versus 21% in those without (p = 0.56). Prevalence of hypertension at the initial visit was much higher in those with MI or stroke than those without (94 vs. 43%, p < 0.001). No association was seen between radiation therapy and stroke. CONCLUSIONS For acromegaly patients being treated at specialized centres, the incidence of MIs and strokes does not seem to differ from the general population. Certainty regarding such statements requires large, prospective studies however.
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Affiliation(s)
- Christof Schöfl
- Centre of Endocrinology and Metabolism, Obstmarkt 1, 96047, Bamberg, Germany.
| | - David Petroff
- Clinical Trial Centre, University of Leipzig, Leipzig, Germany
| | - Anke Tönjes
- Division of Endocrinology and Nephrology, Medical Department, University of Leipzig, Leipzig, Germany
| | | | | | | | | | - Sylvère Störmann
- Medizinische Klinik IV, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Jochen Schopohl
- Medizinische Klinik IV, Ludwig-Maximilians-University Munich, Munich, Germany
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13
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Petersenn S, Christ-Crain M, Droste M, Finke R, Flitsch J, Kreitschmann-Andermahr I, Luger A, Schopohl J, Stalla G. [Diagnostics and treatment of acromegaly : Necessity for targeted monitoring of comorbidities]. Internist (Berl) 2017; 58:1171-1182. [PMID: 29027568 DOI: 10.1007/s00108-017-0331-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Acromegaly is a rare and severe condition, presenting with typical signs and symptoms. The diagnosis is often initially made years after the first manifestations of the disease. In more than 99% of patients the disease is caused by a benign pituitary tumor that secretes growth hormone (GH). The diagnosis is based on the presence of increased insulin-like growth factor 1 (IGF-1) levels and a lack of GH suppression in the oral glucose tolerance test. The standard imaging procedure for tumor detection is magnetic resonance imaging in the region of the sella turcica. Treatment includes surgical, drug and radiation therapy. Important factors are an intensive aftercare of the patient, controls for detection of tumor recurrence and pituitary insufficiency as well as assessment of various organ functions and risk constellations. Patient care should involve close cooperation between endocrinologists, neurosurgeons and general practitioners as well as other specialist disciplines.
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Affiliation(s)
- S Petersenn
- ENDOC Praxis für Endokrinologie, Andrologie und medikamentöse Tumortherapie, Erik-Blumenfeld-Platz 27A, 22587, Hamburg, Deutschland.
| | - M Christ-Crain
- Endokrinologie, Diabetologie & Metabolismus, Universitätsspital Basel, Basel, Schweiz
| | - M Droste
- Endokrinologie, Diabetologie, Hormonanalytik, Medicover MVZ, Oldenburg, Deutschland
| | - R Finke
- Innere Medizin, Endokrinologie/Diabetologie & Allgemeinmedizin, Praxisgemeinschaft an der Kaisereiche, Berlin, Deutschland
| | - J Flitsch
- Klinik und Poliklinik für Neurochirurgie, Kopf- und Neurozentrum, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - I Kreitschmann-Andermahr
- Neurochirurgische Klinik, Universitätsklinikum Essen, Universität Duisburg-Essen, Essen, Deutschland
| | - A Luger
- Klinische Abteilung für Endokrinologie & Stoffwechsel, Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Wien, Österreich
| | - J Schopohl
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, München, Deutschland
| | - G Stalla
- Innere Medizin, Endokrinologie und Klinische Chemie, Max-Planck-Institut für Psychiatrie, München, Deutschland
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14
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Petrossians P, Daly AF, Natchev E, Maione L, Blijdorp K, Sahnoun-Fathallah M, Auriemma R, Diallo AM, Hulting AL, Ferone D, Hana V, Filipponi S, Sievers C, Nogueira C, Fajardo-Montañana C, Carvalho D, Hana V, Stalla GK, Jaffrain-Réa ML, Delemer B, Colao A, Brue T, Neggers SJCMM, Zacharieva S, Chanson P, Beckers A. Acromegaly at diagnosis in 3173 patients from the Liège Acromegaly Survey (LAS) Database. Endocr Relat Cancer 2017; 24:505-518. [PMID: 28733467 PMCID: PMC5574208 DOI: 10.1530/erc-17-0253] [Citation(s) in RCA: 121] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 07/21/2017] [Indexed: 12/27/2022]
Abstract
Acromegaly is a rare disorder caused by chronic growth hormone (GH) hypersecretion. While diagnostic and therapeutic methods have advanced, little information exists on trends in acromegaly characteristics over time. The Liège Acromegaly Survey (LAS) Database, a relational database, is designed to assess the profile of acromegaly patients at diagnosis and during long-term follow-up at multiple treatment centers. The following results were obtained at diagnosis. The study population consisted of 3173 acromegaly patients from ten countries; 54.5% were female. Males were significantly younger at diagnosis than females (43.5 vs 46.4 years; P < 0.001). The median delay from first symptoms to diagnosis was 2 years longer in females (P = 0.015). Ages at diagnosis and first symptoms increased significantly over time (P < 0.001). Tumors were larger in males than females (P < 0.001); tumor size and invasion were inversely related to patient age (P < 0.001). Random GH at diagnosis correlated with nadir GH levels during OGTT (P < 0.001). GH was inversely related to age in both sexes (P < 0.001). Diabetes mellitus was present in 27.5%, hypertension in 28.8%, sleep apnea syndrome in 25.5% and cardiac hypertrophy in 15.5%. Serious cardiovascular outcomes like stroke, heart failure and myocardial infarction were present in <5% at diagnosis. Erythrocyte levels were increased and correlated with IGF-1 values. Thyroid nodules were frequent (34.0%); 820 patients had colonoscopy at diagnosis and 13% had polyps. Osteoporosis was present at diagnosis in 12.3% and 0.6-4.4% had experienced a fracture. In conclusion, this study of >3100 patients is the largest international acromegaly database and shows clinically relevant trends in the characteristics of acromegaly at diagnosis.
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Affiliation(s)
| | - Adrian F Daly
- Department of EndocrinologyCHU de Liège, University of Liège, Belgium
| | - Emil Natchev
- Clinical Centre of Endocrinology and GerontologyMedical University, Sofia, Bulgaria
| | - Luigi Maione
- APHP Endocrinology and Reproductive DiseasesParis Sud University, Le Kremlin-Bicêtre, France
| | - Karin Blijdorp
- Section of EndocrinologyDepartment of Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Mona Sahnoun-Fathallah
- Department of EndocrinologyCentre de Référence des Maladies Rares d'Origine Hypophysaire, Hôpital de la Timone, Marseille, France
| | - Renata Auriemma
- Dipartimento Di Medicina Clinica e ChirurgiaSezione di Endocrinologia, University "Federico II", Naples, Italy
| | | | - Anna-Lena Hulting
- Department of Molecular Medicine and SurgeryKarolinska University Hospital, Stockholm, Sweden
| | - Diego Ferone
- Department of Internal MedicineUniversity of Genoa, Genova, Italy
| | - Vaclav Hana
- Third Department of Internal Medicine1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Silvia Filipponi
- Department of Biotechnological and Applied Clinical SciencesUniversity of L'Aquila, L'Aquila, Italy and Neuromed, IRCCS, Pozzilli, Italy
| | - Caroline Sievers
- Department of Internal MedicineEndocrinology and Clinical Chemistry, Max Planck Institute of Psychiatry, Munich, Germany
| | - Claudia Nogueira
- Department of Internal MedicineEndocrinology, Diabetes and Metabolism Unit, Centro Hospitalar de Trás-os-Montes e Alto Douro, Portugal
| | | | - Davide Carvalho
- Department of EndocrinologyDiabetes and Metabolism, Centro Hospitalar S. João, Faculty of Medicine, Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal
| | - Vaclav Hana
- Third Department of Internal Medicine1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Günter K Stalla
- Department of Internal MedicineEndocrinology and Clinical Chemistry, Max Planck Institute of Psychiatry, Munich, Germany
| | - Marie-Lise Jaffrain-Réa
- Department of Biotechnological and Applied Clinical SciencesUniversity of L'Aquila, L'Aquila, Italy and Neuromed, IRCCS, Pozzilli, Italy
| | | | - Annamaria Colao
- Dipartimento Di Medicina Clinica e ChirurgiaSezione di Endocrinologia, University "Federico II", Naples, Italy
| | - Thierry Brue
- Department of EndocrinologyCentre de Référence des Maladies Rares d'Origine Hypophysaire, Hôpital de la Timone, Marseille, France
| | - Sebastian J C M M Neggers
- Section of EndocrinologyDepartment of Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Sabina Zacharieva
- Clinical Centre of Endocrinology and GerontologyMedical University, Sofia, Bulgaria
| | - Philippe Chanson
- APHP Endocrinology and Reproductive DiseasesParis Sud University, Le Kremlin-Bicêtre, France
| | - Albert Beckers
- Department of EndocrinologyCHU de Liège, University of Liège, Belgium
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15
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Portocarrero-Ortiz LA, Vergara-Lopez A, Vidrio-Velazquez M, Uribe-Diaz AM, García-Dominguez A, Reza-Albarrán AA, Cuevas-Ramos D, Melgar V, Talavera J, Rivera-Hernandez ADJ, Valencia-Méndez CV, Mercado M. The Mexican Acromegaly Registry: Clinical and Biochemical Characteristics at Diagnosis and Therapeutic Outcomes. J Clin Endocrinol Metab 2016; 101:3997-4004. [PMID: 27428551 DOI: 10.1210/jc.2016-1937] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
CONTEXT Acromegaly is a systemic disorder caused by a GH-secreting pituitary adenoma. As with other rare diseases, acromegaly registries developed in various European countries have provided us with important information. OBJECTIVE The objective of the study was to analyze the epidemiological, clinical, biochemical, and therapeutic data from the Mexican Acromegaly Registry (MAR). SETTING The setting of the study was a nationwide patient registry. DESIGN AND METHODOLOGY The MAR was created in 2009. It gathers data from 24 participating centers belonging to three different institutions using a specifically designed on-line platform. Only patients diagnosed after 1990 were included in the program. RESULTS A total of 2057 patients (51% female, mean age at diagnosis 41.1 ± 24.5 y) have been registered for an estimated prevalence of 18 cases per 1 million inhabitants. Hypertension, glucose intolerance, diabetes, and dyslipidemia were present in 27%, 18.4%, 30%, and 24% of the patients, respectively. The IGF-1 level at diagnosis and the concomitant presence of hypertension were significantly associated with the development of diabetes. Transsphenoidal surgery was the primary treatment in 72% of the patients. Pharmacological treatment, mostly with somatostatin analogs, was administered primarily and adjunctively in 26% and 54% of the patients, respectively. Treatment choice varied among the three participating institutions, with the predominance of pharmacological therapy in two of them and of radiation therapy in the third. Therapeutic outcomes were similar to those reported in the European registries. CONCLUSIONS The MAR is the largest and first non-European registry of the disease. Our findings highlight important within-country differences in treatment choice due to variations in the availability of resources.
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Affiliation(s)
- Lesly A Portocarrero-Ortiz
- Instituto Nacional de Neurología y Neurocirugía (L.A.P.-O., C.V.V.-M.), 14269 Mexico City, Mexico; Centro Medico Nacional 20 de Noviembre Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (A.V.-L.), 03100 Mexico City, Mexico; Hospital Regional 110, Instituto Mexicano del Seguro Social (M.V.-V.), 44716 Guadalajara, Jal, Mexico; Unidad Medica de Alta Especialidad 189 (A.M.U.-D.), 91755 Veracruz, Ver, Mexico; Unidad Medica de Alta Especialidad Manuel Avila Camacho (A.G.-D.), Instituto Mexicano del Seguro Social, 7200 Puebla, Pue, Mexico; Instituto Nacional de Ciencias Medicas y Nutricion (A.-A.R.-A., D.C.-R.), 14080 Mexico City, Mexico; ABC Neurological Center (V.M., J.T., M.M.), 05300 Mexico City, Mexico; Hospital General Zaragoza (A.d.J.R.-H.), Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, 09100 Mexico City, Mexico; and Hospital de Especialidades Centro Medico Nacional S.XXI, Instituto Mexicano del Seguro Social (M.M.), 01120 Mexico City, Mexico
| | - Alma Vergara-Lopez
- Instituto Nacional de Neurología y Neurocirugía (L.A.P.-O., C.V.V.-M.), 14269 Mexico City, Mexico; Centro Medico Nacional 20 de Noviembre Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (A.V.-L.), 03100 Mexico City, Mexico; Hospital Regional 110, Instituto Mexicano del Seguro Social (M.V.-V.), 44716 Guadalajara, Jal, Mexico; Unidad Medica de Alta Especialidad 189 (A.M.U.-D.), 91755 Veracruz, Ver, Mexico; Unidad Medica de Alta Especialidad Manuel Avila Camacho (A.G.-D.), Instituto Mexicano del Seguro Social, 7200 Puebla, Pue, Mexico; Instituto Nacional de Ciencias Medicas y Nutricion (A.-A.R.-A., D.C.-R.), 14080 Mexico City, Mexico; ABC Neurological Center (V.M., J.T., M.M.), 05300 Mexico City, Mexico; Hospital General Zaragoza (A.d.J.R.-H.), Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, 09100 Mexico City, Mexico; and Hospital de Especialidades Centro Medico Nacional S.XXI, Instituto Mexicano del Seguro Social (M.M.), 01120 Mexico City, Mexico
| | - Maricela Vidrio-Velazquez
- Instituto Nacional de Neurología y Neurocirugía (L.A.P.-O., C.V.V.-M.), 14269 Mexico City, Mexico; Centro Medico Nacional 20 de Noviembre Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (A.V.-L.), 03100 Mexico City, Mexico; Hospital Regional 110, Instituto Mexicano del Seguro Social (M.V.-V.), 44716 Guadalajara, Jal, Mexico; Unidad Medica de Alta Especialidad 189 (A.M.U.-D.), 91755 Veracruz, Ver, Mexico; Unidad Medica de Alta Especialidad Manuel Avila Camacho (A.G.-D.), Instituto Mexicano del Seguro Social, 7200 Puebla, Pue, Mexico; Instituto Nacional de Ciencias Medicas y Nutricion (A.-A.R.-A., D.C.-R.), 14080 Mexico City, Mexico; ABC Neurological Center (V.M., J.T., M.M.), 05300 Mexico City, Mexico; Hospital General Zaragoza (A.d.J.R.-H.), Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, 09100 Mexico City, Mexico; and Hospital de Especialidades Centro Medico Nacional S.XXI, Instituto Mexicano del Seguro Social (M.M.), 01120 Mexico City, Mexico
| | - Ana María Uribe-Diaz
- Instituto Nacional de Neurología y Neurocirugía (L.A.P.-O., C.V.V.-M.), 14269 Mexico City, Mexico; Centro Medico Nacional 20 de Noviembre Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (A.V.-L.), 03100 Mexico City, Mexico; Hospital Regional 110, Instituto Mexicano del Seguro Social (M.V.-V.), 44716 Guadalajara, Jal, Mexico; Unidad Medica de Alta Especialidad 189 (A.M.U.-D.), 91755 Veracruz, Ver, Mexico; Unidad Medica de Alta Especialidad Manuel Avila Camacho (A.G.-D.), Instituto Mexicano del Seguro Social, 7200 Puebla, Pue, Mexico; Instituto Nacional de Ciencias Medicas y Nutricion (A.-A.R.-A., D.C.-R.), 14080 Mexico City, Mexico; ABC Neurological Center (V.M., J.T., M.M.), 05300 Mexico City, Mexico; Hospital General Zaragoza (A.d.J.R.-H.), Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, 09100 Mexico City, Mexico; and Hospital de Especialidades Centro Medico Nacional S.XXI, Instituto Mexicano del Seguro Social (M.M.), 01120 Mexico City, Mexico
| | - Avril García-Dominguez
- Instituto Nacional de Neurología y Neurocirugía (L.A.P.-O., C.V.V.-M.), 14269 Mexico City, Mexico; Centro Medico Nacional 20 de Noviembre Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (A.V.-L.), 03100 Mexico City, Mexico; Hospital Regional 110, Instituto Mexicano del Seguro Social (M.V.-V.), 44716 Guadalajara, Jal, Mexico; Unidad Medica de Alta Especialidad 189 (A.M.U.-D.), 91755 Veracruz, Ver, Mexico; Unidad Medica de Alta Especialidad Manuel Avila Camacho (A.G.-D.), Instituto Mexicano del Seguro Social, 7200 Puebla, Pue, Mexico; Instituto Nacional de Ciencias Medicas y Nutricion (A.-A.R.-A., D.C.-R.), 14080 Mexico City, Mexico; ABC Neurological Center (V.M., J.T., M.M.), 05300 Mexico City, Mexico; Hospital General Zaragoza (A.d.J.R.-H.), Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, 09100 Mexico City, Mexico; and Hospital de Especialidades Centro Medico Nacional S.XXI, Instituto Mexicano del Seguro Social (M.M.), 01120 Mexico City, Mexico
| | - Alfredo Adolfo Reza-Albarrán
- Instituto Nacional de Neurología y Neurocirugía (L.A.P.-O., C.V.V.-M.), 14269 Mexico City, Mexico; Centro Medico Nacional 20 de Noviembre Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (A.V.-L.), 03100 Mexico City, Mexico; Hospital Regional 110, Instituto Mexicano del Seguro Social (M.V.-V.), 44716 Guadalajara, Jal, Mexico; Unidad Medica de Alta Especialidad 189 (A.M.U.-D.), 91755 Veracruz, Ver, Mexico; Unidad Medica de Alta Especialidad Manuel Avila Camacho (A.G.-D.), Instituto Mexicano del Seguro Social, 7200 Puebla, Pue, Mexico; Instituto Nacional de Ciencias Medicas y Nutricion (A.-A.R.-A., D.C.-R.), 14080 Mexico City, Mexico; ABC Neurological Center (V.M., J.T., M.M.), 05300 Mexico City, Mexico; Hospital General Zaragoza (A.d.J.R.-H.), Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, 09100 Mexico City, Mexico; and Hospital de Especialidades Centro Medico Nacional S.XXI, Instituto Mexicano del Seguro Social (M.M.), 01120 Mexico City, Mexico
| | - Daniel Cuevas-Ramos
- Instituto Nacional de Neurología y Neurocirugía (L.A.P.-O., C.V.V.-M.), 14269 Mexico City, Mexico; Centro Medico Nacional 20 de Noviembre Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (A.V.-L.), 03100 Mexico City, Mexico; Hospital Regional 110, Instituto Mexicano del Seguro Social (M.V.-V.), 44716 Guadalajara, Jal, Mexico; Unidad Medica de Alta Especialidad 189 (A.M.U.-D.), 91755 Veracruz, Ver, Mexico; Unidad Medica de Alta Especialidad Manuel Avila Camacho (A.G.-D.), Instituto Mexicano del Seguro Social, 7200 Puebla, Pue, Mexico; Instituto Nacional de Ciencias Medicas y Nutricion (A.-A.R.-A., D.C.-R.), 14080 Mexico City, Mexico; ABC Neurological Center (V.M., J.T., M.M.), 05300 Mexico City, Mexico; Hospital General Zaragoza (A.d.J.R.-H.), Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, 09100 Mexico City, Mexico; and Hospital de Especialidades Centro Medico Nacional S.XXI, Instituto Mexicano del Seguro Social (M.M.), 01120 Mexico City, Mexico
| | - Virgilio Melgar
- Instituto Nacional de Neurología y Neurocirugía (L.A.P.-O., C.V.V.-M.), 14269 Mexico City, Mexico; Centro Medico Nacional 20 de Noviembre Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (A.V.-L.), 03100 Mexico City, Mexico; Hospital Regional 110, Instituto Mexicano del Seguro Social (M.V.-V.), 44716 Guadalajara, Jal, Mexico; Unidad Medica de Alta Especialidad 189 (A.M.U.-D.), 91755 Veracruz, Ver, Mexico; Unidad Medica de Alta Especialidad Manuel Avila Camacho (A.G.-D.), Instituto Mexicano del Seguro Social, 7200 Puebla, Pue, Mexico; Instituto Nacional de Ciencias Medicas y Nutricion (A.-A.R.-A., D.C.-R.), 14080 Mexico City, Mexico; ABC Neurological Center (V.M., J.T., M.M.), 05300 Mexico City, Mexico; Hospital General Zaragoza (A.d.J.R.-H.), Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, 09100 Mexico City, Mexico; and Hospital de Especialidades Centro Medico Nacional S.XXI, Instituto Mexicano del Seguro Social (M.M.), 01120 Mexico City, Mexico
| | - Juan Talavera
- Instituto Nacional de Neurología y Neurocirugía (L.A.P.-O., C.V.V.-M.), 14269 Mexico City, Mexico; Centro Medico Nacional 20 de Noviembre Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (A.V.-L.), 03100 Mexico City, Mexico; Hospital Regional 110, Instituto Mexicano del Seguro Social (M.V.-V.), 44716 Guadalajara, Jal, Mexico; Unidad Medica de Alta Especialidad 189 (A.M.U.-D.), 91755 Veracruz, Ver, Mexico; Unidad Medica de Alta Especialidad Manuel Avila Camacho (A.G.-D.), Instituto Mexicano del Seguro Social, 7200 Puebla, Pue, Mexico; Instituto Nacional de Ciencias Medicas y Nutricion (A.-A.R.-A., D.C.-R.), 14080 Mexico City, Mexico; ABC Neurological Center (V.M., J.T., M.M.), 05300 Mexico City, Mexico; Hospital General Zaragoza (A.d.J.R.-H.), Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, 09100 Mexico City, Mexico; and Hospital de Especialidades Centro Medico Nacional S.XXI, Instituto Mexicano del Seguro Social (M.M.), 01120 Mexico City, Mexico
| | - Aleida de Jesus Rivera-Hernandez
- Instituto Nacional de Neurología y Neurocirugía (L.A.P.-O., C.V.V.-M.), 14269 Mexico City, Mexico; Centro Medico Nacional 20 de Noviembre Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (A.V.-L.), 03100 Mexico City, Mexico; Hospital Regional 110, Instituto Mexicano del Seguro Social (M.V.-V.), 44716 Guadalajara, Jal, Mexico; Unidad Medica de Alta Especialidad 189 (A.M.U.-D.), 91755 Veracruz, Ver, Mexico; Unidad Medica de Alta Especialidad Manuel Avila Camacho (A.G.-D.), Instituto Mexicano del Seguro Social, 7200 Puebla, Pue, Mexico; Instituto Nacional de Ciencias Medicas y Nutricion (A.-A.R.-A., D.C.-R.), 14080 Mexico City, Mexico; ABC Neurological Center (V.M., J.T., M.M.), 05300 Mexico City, Mexico; Hospital General Zaragoza (A.d.J.R.-H.), Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, 09100 Mexico City, Mexico; and Hospital de Especialidades Centro Medico Nacional S.XXI, Instituto Mexicano del Seguro Social (M.M.), 01120 Mexico City, Mexico
| | - Carla Valentina Valencia-Méndez
- Instituto Nacional de Neurología y Neurocirugía (L.A.P.-O., C.V.V.-M.), 14269 Mexico City, Mexico; Centro Medico Nacional 20 de Noviembre Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (A.V.-L.), 03100 Mexico City, Mexico; Hospital Regional 110, Instituto Mexicano del Seguro Social (M.V.-V.), 44716 Guadalajara, Jal, Mexico; Unidad Medica de Alta Especialidad 189 (A.M.U.-D.), 91755 Veracruz, Ver, Mexico; Unidad Medica de Alta Especialidad Manuel Avila Camacho (A.G.-D.), Instituto Mexicano del Seguro Social, 7200 Puebla, Pue, Mexico; Instituto Nacional de Ciencias Medicas y Nutricion (A.-A.R.-A., D.C.-R.), 14080 Mexico City, Mexico; ABC Neurological Center (V.M., J.T., M.M.), 05300 Mexico City, Mexico; Hospital General Zaragoza (A.d.J.R.-H.), Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, 09100 Mexico City, Mexico; and Hospital de Especialidades Centro Medico Nacional S.XXI, Instituto Mexicano del Seguro Social (M.M.), 01120 Mexico City, Mexico
| | - Moisés Mercado
- Instituto Nacional de Neurología y Neurocirugía (L.A.P.-O., C.V.V.-M.), 14269 Mexico City, Mexico; Centro Medico Nacional 20 de Noviembre Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (A.V.-L.), 03100 Mexico City, Mexico; Hospital Regional 110, Instituto Mexicano del Seguro Social (M.V.-V.), 44716 Guadalajara, Jal, Mexico; Unidad Medica de Alta Especialidad 189 (A.M.U.-D.), 91755 Veracruz, Ver, Mexico; Unidad Medica de Alta Especialidad Manuel Avila Camacho (A.G.-D.), Instituto Mexicano del Seguro Social, 7200 Puebla, Pue, Mexico; Instituto Nacional de Ciencias Medicas y Nutricion (A.-A.R.-A., D.C.-R.), 14080 Mexico City, Mexico; ABC Neurological Center (V.M., J.T., M.M.), 05300 Mexico City, Mexico; Hospital General Zaragoza (A.d.J.R.-H.), Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, 09100 Mexico City, Mexico; and Hospital de Especialidades Centro Medico Nacional S.XXI, Instituto Mexicano del Seguro Social (M.M.), 01120 Mexico City, Mexico
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Maffezzoni F, Formenti AM, Mazziotti G, Frara S, Giustina A. Current and future medical treatments for patients with acromegaly. Expert Opin Pharmacother 2016; 17:1631-42. [PMID: 27352098 DOI: 10.1080/14656566.2016.1199687] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Acromegaly is a relatively rare condition of growth hormone (GH) excess associated with significant morbidity and, when left untreated, high mortality. Therapy for acromegaly is targeted at decreasing GH and insulin-like growth hormone 1 levels, ameliorating patients' symptoms and decreasing any local compressive effects of the pituitary adenoma. The therapeutic options for acromegaly include surgery, medical therapies (such as dopamine agonists, somatostatin receptor ligands and the GH receptor antagonist pegvisomant) and radiotherapy. However, despite all these treatments option, approximately 50% of patients are not adequately controlled. AREAS COVERED In this paper, the authors discuss: 1) efficacy and safety of current medical therapy 2) the efficacy and safety of the new multireceptor-targeted somatostatin ligand pasireotide 3) medical treatments currently under clinical investigation (oral octreotide, ITF2984, ATL1103), and 4) preliminary data on the use of new injectable and transdermal/transmucosal formulations of octreotide. EXPERT OPINION This expert opinion supports the need for new therapeutic agents and modalities for patients with acromegaly.
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Affiliation(s)
| | | | | | - Stefano Frara
- a Chair of Endocrinology , University of Brescia , Brescia , Italy
| | - Andrea Giustina
- a Chair of Endocrinology , University of Brescia , Brescia , Italy
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Schöfl C, Grussendorf M, Honegger J, Tönjes A, Thyroke-Gronostay D, Mayr B, Schopohl J. Failure to achieve disease control in acromegaly: cause analysis by a registry-based survey. Eur J Endocrinol 2015; 172:351-6. [PMID: 25599707 DOI: 10.1530/eje-14-0844] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
CONTEXT Disease control is a prime target in acromegaly treatment. This should be achievable in the vast majority of patients by available treatment options. For unknown reasons, however, a significant number of patients do not achieve disease control. OBJECTIVE To investigate reasons for failure to achieve disease control in long-standing acromegaly. DESIGN AND METHODS Survey based on the German Acromegaly Registry database (1755 patients in 57 centres). Questionnaires were sent to 47 centres treating 178 patients with elevated disease markers (IGF1 and GH) at the last documented database visit out of 1528 patients with a diagnosis dated back ≥2 years. Thirty-three centres returned anonymised information for 120 patients (recall rate 67.4%). RESULTS Median age of the 120 patients (58 females) was 57 years (range 17-84). Ninety-four patients had at least one operation, 29 had received radiotherapy and 71 had been previously treated medically. Comorbidities were reported in 67 patients. In 61 patients, disease activity had been controlled since the last documented database visit, while 59 patients still had biochemically active disease. Reasons were patients' denial to escalate therapy (23.3%), non-compliance (20.6%), fluctuating insulin-like growth factor 1 (IGF-1) and growth hormone (GH) levels with normal values at previous visits (23.3%) and modifications in pharmacotherapy (15.1%). Therapy resistance (9.6%), drug side effects (4.1%) and economic considerations (4.1%) were rare reasons. CONCLUSIONS Main reasons for long-standing active acromegaly were patients' lack of motivation to agree to therapeutic recommendations and non-compliance with medical therapy. Development of patient education programmes could improve long-term control and thus prognosis of acromegalic patients.
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Affiliation(s)
- Christof Schöfl
- Division of Endocrinology and DiabetesDepartment of Medicine 1, Friedrich-Alexander University Erlangen-Nuremberg, Ulmenweg 18, 91054 Erlangen, GermanyCenter of Endocrinology and DiabetesStuttgart, GermanyDepartment of NeurosurgeryEberhard Karls University Tuebingen, Tuebingen, GermanyMedical DepartmentUniversity of Leipzig, Leipzig, GermanyLohmann and Birkner Health Care Consulting GmbHBerlin, GermanyMedizinische Klinik IVLudwig-Maximilian-University Munich, Munich, Germany
| | - Martin Grussendorf
- Division of Endocrinology and DiabetesDepartment of Medicine 1, Friedrich-Alexander University Erlangen-Nuremberg, Ulmenweg 18, 91054 Erlangen, GermanyCenter of Endocrinology and DiabetesStuttgart, GermanyDepartment of NeurosurgeryEberhard Karls University Tuebingen, Tuebingen, GermanyMedical DepartmentUniversity of Leipzig, Leipzig, GermanyLohmann and Birkner Health Care Consulting GmbHBerlin, GermanyMedizinische Klinik IVLudwig-Maximilian-University Munich, Munich, Germany
| | - Jürgen Honegger
- Division of Endocrinology and DiabetesDepartment of Medicine 1, Friedrich-Alexander University Erlangen-Nuremberg, Ulmenweg 18, 91054 Erlangen, GermanyCenter of Endocrinology and DiabetesStuttgart, GermanyDepartment of NeurosurgeryEberhard Karls University Tuebingen, Tuebingen, GermanyMedical DepartmentUniversity of Leipzig, Leipzig, GermanyLohmann and Birkner Health Care Consulting GmbHBerlin, GermanyMedizinische Klinik IVLudwig-Maximilian-University Munich, Munich, Germany
| | - Anke Tönjes
- Division of Endocrinology and DiabetesDepartment of Medicine 1, Friedrich-Alexander University Erlangen-Nuremberg, Ulmenweg 18, 91054 Erlangen, GermanyCenter of Endocrinology and DiabetesStuttgart, GermanyDepartment of NeurosurgeryEberhard Karls University Tuebingen, Tuebingen, GermanyMedical DepartmentUniversity of Leipzig, Leipzig, GermanyLohmann and Birkner Health Care Consulting GmbHBerlin, GermanyMedizinische Klinik IVLudwig-Maximilian-University Munich, Munich, Germany
| | - Daniel Thyroke-Gronostay
- Division of Endocrinology and DiabetesDepartment of Medicine 1, Friedrich-Alexander University Erlangen-Nuremberg, Ulmenweg 18, 91054 Erlangen, GermanyCenter of Endocrinology and DiabetesStuttgart, GermanyDepartment of NeurosurgeryEberhard Karls University Tuebingen, Tuebingen, GermanyMedical DepartmentUniversity of Leipzig, Leipzig, GermanyLohmann and Birkner Health Care Consulting GmbHBerlin, GermanyMedizinische Klinik IVLudwig-Maximilian-University Munich, Munich, Germany
| | - Bernhard Mayr
- Division of Endocrinology and DiabetesDepartment of Medicine 1, Friedrich-Alexander University Erlangen-Nuremberg, Ulmenweg 18, 91054 Erlangen, GermanyCenter of Endocrinology and DiabetesStuttgart, GermanyDepartment of NeurosurgeryEberhard Karls University Tuebingen, Tuebingen, GermanyMedical DepartmentUniversity of Leipzig, Leipzig, GermanyLohmann and Birkner Health Care Consulting GmbHBerlin, GermanyMedizinische Klinik IVLudwig-Maximilian-University Munich, Munich, Germany
| | - Jochen Schopohl
- Division of Endocrinology and DiabetesDepartment of Medicine 1, Friedrich-Alexander University Erlangen-Nuremberg, Ulmenweg 18, 91054 Erlangen, GermanyCenter of Endocrinology and DiabetesStuttgart, GermanyDepartment of NeurosurgeryEberhard Karls University Tuebingen, Tuebingen, GermanyMedical DepartmentUniversity of Leipzig, Leipzig, GermanyLohmann and Birkner Health Care Consulting GmbHBerlin, GermanyMedizinische Klinik IVLudwig-Maximilian-University Munich, Munich, Germany
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Schöfl C, Honegger J, Droste M, Grussendorf M, Finke R, Plöckinger U, Berg C, Willenberg HS, Lammert A, Klingmüller D, Jaursch-Hancke C, Tönjes A, Schneidewind S, Flitsch J, Bullmann C, Dimopoulou C, Stalla G, Mayr B, Hoeppner W, Schopohl J. Frequency of AIP gene mutations in young patients with acromegaly: a registry-based study. J Clin Endocrinol Metab 2014; 99:E2789-93. [PMID: 25093619 DOI: 10.1210/jc.2014-2094] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
CONTEXT Familial and sporadic GH-secreting pituitary adenomas are associated with mutations in the aryl hydrocarbon receptor-interacting protein (AIP) gene. Patients with an AIP mutation (AIPmut) tend to have more aggressive tumors occurring at a younger age. OBJECTIVE The objective of the study was to investigate the frequency of AIPmut in patients diagnosed at 30 years of age or younger. DESIGN The German Acromegaly Registry database (1795 patients in 58 centers) was screened for patients diagnosed with acromegaly at 30 years of age or younger (329 patients). Sixteen centers participated and 91 patients consented to AIPmut analysis. INTERVENTION DNA was analyzed by direct sequencing and multiplex ligation dependent probe amplification Main outcome Measures: The number of patients with AIPmut was measured. RESULTS Five patients had either a mutation (c.490C>T, c.844C>T, and c.911G>A, three males) or gross deletions of exons 1 and 2 of the AIP gene (n = 2, one female). The overall frequency of an AIPmut was 5.5%, and 2.3% or 2.4% in patients with an apparently sporadic adenoma or macroadenoma, respectively. By contrast, three of four patients (75%) with a positive family history were tested positive for an AIPmut. Except for a positive family history, there were no significant differences between patients with and without an AIPmut. CONCLUSIONS The frequency of AIPmut in this registry-based cohort of young patients with acromegaly is lower than previously reported. Patients with a positive family history should be tested for an AIPmut, whereas young patients without an apparent family history should be screened, depending on the individual cost to benefit ratio.
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Affiliation(s)
- Christof Schöfl
- Division of Endocrinology and Diabetes (C.S., B.M.), Department of Medicine I, Friedrich-Alexander-University Erlangen-Nuremberg, 91054 Erlangen, Germany; Department of Neurosurgery (J.H.), Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany; Endocrine Practice (M.D.), 26122 Oldenburg, Germany; Center of Endocrinology and Diabetes (M.G.), 70178 Stuttgart, Germany; Endocrine Practice Kaisereiche (R.F.), 12159 Berlin, Germany; Interdisciplinary Center of Metabolism: Endocrinology, Diabetes, and Metabolism (U.P.), Charite-University-Medicine Berlin, 13352 Berlin, Germany; Department of Endocrinology (C.Be.), University Hospital of Essen, 45147 Essen, Germany; Division of Special Endocrinology (H.S.W.), Department of Endocrinology and Diabetes, Medical Faculty, Heinrich-Heine University Düsseldorf, 40225 Düsseldorf, Germany; Fifth Medical Clinic (A.L.), University Medical Center Mannheim, University of Heidelberg, 68167 Heidelberg, Germany; Division of Endocrinology and Diabetes (D.K.), Department of Medicine I, Rheinische Friedrich-Wilhelms-University Bonn, 53127 Bonn, Germany; Department of Endocrinology (C.J.-H.), German Clinic of Diagnostics, Wiesbaden, 65191 Wiesbaden, Germany; Medical Department III (A.T.), University of Leipzig, 04103 Leipzig, Germany; Department of Gastroenterology, Hepatology, and Endocrinology (S.S.), Hannover Medical School, 30625 Hannover, Germany; Pituitary Surgery/Interdisciplinary Endocrinology (J.F.), UKE Hamburg, 20246 Hamburg, Germany; Endocrine Practice (C.Bu.), 20095 Hamburg, Germany; Max Planck Institute of Psychiatry (C.D., G.S.), 80804 Munich, Germany; Bioglobe GmbH (W.H.), 22529 Hamburg, Germany; and Medizinische Klinik IV (J.S.), Ludwig-Maximilians-University 80336 Munich, Germany
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Prevalencia e incidencia de los principales trastornos endocrinos y metabólicos. REVISTA MÉDICA CLÍNICA LAS CONDES 2013. [DOI: 10.1016/s0716-8640(13)70217-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Kwon O, Song YD, Kim SY, Lee EJ. Nationwide survey of acromegaly in South Korea. Clin Endocrinol (Oxf) 2013; 78:577-85. [PMID: 22909047 DOI: 10.1111/cen.12020] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2012] [Revised: 07/20/2012] [Accepted: 08/17/2012] [Indexed: 11/29/2022]
Abstract
CONTEXT It was previously reported in Korea that there were 1.4 case per million per year of acromegaly. This was low in comparison with the extrapolated values of Western European countries. We expected that the incidence of acromegaly would be much higher now because of recently improved medical facilities, diagnostic tools and coverage of medical insurance to all the population of South Korea. OBJECTIVE The purpose of this nationwide survey was to examine the incidence and prevalence of patients with acromegaly, mode of treatment and outcome of surgical treatment of recent 5 years. DESIGN AND PATIENTS We requested and collected the medical records of all possible patients with acromegaly from 74 secondary or tertiary medical institutes in Korea from 2003 to 2007 retrospectively. MEASUREMENTS Date of diagnosis and treatment, tumour size, pre- and postoperative hormonal level, treatment modality and usage of medication were collected. RESULTS During 5 years, 1350 patients with acromegaly had been registered. The average annual incidence was 3.9 cases per million during this period, and prevalence had increased up to 27.9 cases per million in 2007. Male/female ratio was 1:1.2, and mean age at diagnosis was 44.1 years. Macroadenoma was dominant (82.9%). Transsphenoidal adenoidectomy was used the most as primary treatment (90.4%). CONCLUSIONS This Korean acromegaly survey offers a realistic overview of the predominant epidemiological characteristics of acromegaly in Korea. Annual incidence was at a similar level with western countries. Efforts to diagnose and control the disease earlier are recommended.
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Affiliation(s)
- Obin Kwon
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
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Schöfl C, Franz H, Grussendorf M, Honegger J, Jaursch-Hancke C, Mayr B, Schopohl J. Long-term outcome in patients with acromegaly: analysis of 1344 patients from the German Acromegaly Register. Eur J Endocrinol 2013; 168:39-47. [PMID: 23087126 DOI: 10.1530/eje-12-0602] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Acromegaly is a rare disease with significant morbidity and increased mortality. Epidemiological data about therapeutic outcome under 'real life' conditions are scarce. OBJECTIVE To describe biochemical long-term outcome of acromegaly patients in Germany. DESIGN AND METHODS Retrospective data analysis from 1344 patients followed in 42 centers of the German Acromegaly Register. Patients' data were collected 8.6 (range 0-52.6) years after diagnosis. Controlled disease was defined by an IGF1 within the center-specific reference range. RESULTS Nine hundred and seventeen patients showed a normalized IGF1 (157 (range 25-443) ng/ml). In patients with a diagnosis dated back >2 years (n=1013), IGF1 was normalized in 76.9%. Of the patients, 19.5% had an elevated IGF1 and a random GH ≥1 ng/ml, 89% of the patients had at least one surgical intervention, 22% underwent radiotherapy, and 43% received medical treatment. After surgery 38.8% of the patients were controlled without any further therapy. The control rates were higher in surgical centers with a higher caseload (P=0.034). Of the patients with adjunctive radiotherapy 34.8% had a normal IGF1 8.86 (0-44.9) years post irradiation, 65.2% of the medically treated patients were controlled, and 47.2% of the patients with an elevated IGF1 received no medical therapy. CONCLUSION The majority of acromegaly patients were controlled according to their IGF1 status. Long-term outcome could be improved by exploiting medical treatment options especially in patients who are not controlled by surgery and/or radiotherapy.
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Affiliation(s)
- Christof Schöfl
- Department of Medicine I, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany.
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The Liege Acromegaly Survey (LAS): a new software tool for the study of acromegaly. ANNALES D'ENDOCRINOLOGIE 2012; 73:190-201. [PMID: 22682917 DOI: 10.1016/j.ando.2012.05.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2012] [Accepted: 05/01/2012] [Indexed: 01/09/2023]
Abstract
Acromegaly is a chronic rare disease associated with negative pathological effects on multiple systems and organs. We designed a new informatics tool to study data from patients with acromegaly, the Liege Acromegaly Survey (LAS). This relational database permits the inclusion of anonymous historical and prospective data on patients and includes pathophysiology, clinical features, responses to therapy and long term outcomes of acromegaly. We deployed the LAS in a validation study at a single center in order to study the characteristics of patients with acromegaly diagnosed at our center from 1970-2011. A total of 290 patients with acromegaly were included (147 males and 143 females). There was a linear relationship between age at diagnosis and the date of diagnosis, indicating that older patients are being diagnosed with acromegaly more frequently. A majority presented with macroadenomas (77.5%) and the median diameter was 14 mm. Patients with macroadenomas were significantly younger than patients with microadenomas (P=0.01). GH values at diagnosis decreased with the age of the patients (P=0.01) and there was a correlation between GH values and tumor size at diagnosis (P=0.02). No correlation existed between insulin-like growth factor 1 (IGF-1) levels and tumor characteristics. The prevalence of diabetes was 21.4% in this population and 41.0% had hypertension. The presence of hypertension and diabetes were significantly associated with one another (P<0.001). There was a linear relation between initial GH and IGF-1 levels at diagnosis and those obtained during SSA analog treatment and the lowest GH and IGF-1 values following SSA therapy were obtained in older patients (GH: P<0.001; IGF-1: P<0.001). The LAS is a new relational database that is feasible to use in the clinical research setting and permits ready pooling of anonymous patient data from multiple study sites to undertake robust statistical analyses of clinical and therapeutic characteristics.
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Marty R, Roze S, Kurth H. Decision-tree model for health economic comparison of two long-acting somatostatin receptor ligand devices in France, Germany, and the UK. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2012; 5:39-44. [PMID: 23166456 PMCID: PMC3500976 DOI: 10.2147/mder.s30913] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Long-acting somatostatin receptor ligands (SRL) with product-specific formulation and means of administration are injected periodically in patients with acromegaly and neuroendocrine tumors. A simple decision-tree model aimed at comparing cost savings with ready-to-use Somatuline Autogel(®) (lanreotide) and Sandostatin LAR(®) (octreotide) for the UK, France, and Germany. The drivers of cost savings studied were the reduction of time to administer as well as a reduced baseline risk of clogging during product administration reported for Somatuline Autogel(®). METHODS The decision-tree model assumed two settings for SRL administration, ie, by either hospital-based or community-based nurses. In the case of clogging, the first dose was assumed to be lost and a second injection performed. Successful injection depended on the probability of clogging. Direct medical costs were included. A set of scenarios were run, varying the cost drivers, such as the baseline risk of clogging, SRL administration time, and percentage of patients injected during a hospital stay. RESULTS Costs per successful injection were less for Somatuline Autogel(®)/Depot, ranging from Euros (EUR) 13-45, EUR 52-108, and EUR 127-151, respectively, for France, Germany, and the UK. The prices for both long-acting SRL were the same in France, and cost savings came to 100% from differences other than drug prices. For Germany and the UK, the proportion of savings due to less clogging and shorter administration time was estimated to be around 32% and 20%, respectively. Based on low and high country-specific patient cohort size estimations of individuals eligible for SRL treatment among the patient population with acromegaly and neuroendocrine tumors, annual savings were estimated to be up to EUR 2,000,000 for France, EUR 6,000,000 for Germany, and EUR 7,000,000 for the UK. CONCLUSION This model suggests that increasing usage of the Somatuline device for injection of SRL might lead to substantial savings for health care providers across Europe.
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[Rare differential diagnosis in a 40-year old patient with sleep apnea syndrome]. HNO 2012; 60:120-5. [PMID: 22331086 DOI: 10.1007/s00106-011-2310-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Respiratory disorders are common and important complications in acromegaly. The prevalence of sleep apnea syndrome (SAS) in this group of patients is high (20%-50%). Consequences of SAS are serious and associated with increased morbidity and mortality, mainly as a result of cardiovascular complications. The symptoms of sleep apnea are often reversible with treatment. We report on an acromegaly patient presenting with excessive snoring and severe headaches caused by sleep apnea.
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Patel SG. Internet-Based Multi-institutional Clinical Research: A New Method to Conduct and Manage Quality of Life Studies. Skull Base 2011; 20:23-6. [PMID: 20592854 DOI: 10.1055/s-0029-1242981] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Assessment of outcomes after craniofacial surgery for skull base tumors poses unique challenges because of the rarity of the problem and heterogeneity in clinical behavior of these tumors. Collaborative studies of outcome provide an opportunity for meaningful analysis of not just tumor-related outcome, but also quality of life after treatment in these patients. This article introduces the use of a Web-based data collection method that can function as a collaborative registry and a tool for collection of quality of life data.
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Affiliation(s)
- Snehal G Patel
- Department of Surgery, Head and Neck Service, Memorial Sloan-Kettering Cancer Center, New York, New York
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Cannavò S, Ferraù F, Ragonese M, Curtò L, Torre ML, Magistri M, Marchese A, Alibrandi A, Trimarchi F. Increased prevalence of acromegaly in a highly polluted area. Eur J Endocrinol 2010; 163:509-13. [PMID: 20621957 DOI: 10.1530/eje-10-0465] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Despite the contribution of national registries and population-based reports, data concerning the epidemiology of acromegaly is scanty. In addition, the role of the environmental context has not been investigated. DESIGN Epidemiology of acromegaly was studied in the province of Messina (Sicily, Italy), focusing on the influence of environmental factors. METHODS Four zones, characterized by different degrees of exposition to environmental toxins due to industrial pollution, were identified in the province: area A (76,338 inhabitants), area B (287,328 inhabitants), area C (243,381 inhabitants), and area D (47,554 inhabitants) at low, middle-low, middle, and high industrial density respectively. We identified all acromegalics who were born and resided in the province of Messina, among patients either referred to our endocrine unit or referred elsewhere but recorded in the archives of the provincial healthcare agency. RESULTS In the province of Messina, we found 64 patients (2 in area A, 24 in area B, 28 in area C, and 10 in area D). Macroadenomas were 60%, the male/female ratio was 1, and mean age at diagnosis (±s.e.m.) was 45.4±1.6 years. Overall, prevalence was 97 c.p.m. in the province (26 c.p.m. in area A, 84 c.p.m. in area B, 115 c.p.m. in area C, and 210 c.p.m. in area D). Risk ratio (RR), calculated in every area assuming area A as a reference, showed an increased risk of developing acromegaly in people residing in area D (RR=8.03; P<0.0014). CONCLUSION This study confirms the prevalence of acromegaly reported recently. The increased risk of developing this disease in area D suggests that the pathogenetic role of environmental context needs to be better evaluated.
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Affiliation(s)
- S Cannavò
- Section of Endocrinology, Department of Medicine and Pharmacology, University of Messina, Messina, Italy
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Brue T, Castinetti F, Lundgren F, Koltowska-Häggström M, Petrossians P. Which patients with acromegaly are treated with pegvisomant? An overview of methodology and baseline data in ACROSTUDY. Eur J Endocrinol 2009; 161 Suppl 1:S11-7. [PMID: 19684051 DOI: 10.1530/eje-09-0333] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Context Pegvisomant (Somavert, Pfizer Inc.) is the first and only available GH receptor antagonist. ACROSTUDY is an international surveillance study that offers inclusion in a web-based registry to all patients with acromegaly treated with pegvisomant; it aims at monitoring long-term safety and efficacy of this compound. Patients and methods This report summarizes the main baseline characteristics of this particular population of patients. In February 2009, over 300 centres in 10 countries had contributed 792 patients. A gradual increase in cumulative patient recruitment was observed since the launching of ACROSTUDY in 2004: from 116 patients in 2005, it steeply increased to 792 at the latest data freeze in February 2009. At the time of enrolment, 91.8% of patients were already treated with pegvisomant but baseline was considered at the time of pegvisomant start. IGF1 concentrations were measured at local laboratories. Results Of all patients, 80% were reported to have had surgery and 33% to have received radiation therapy. Of the 792 patients, 14% had received no prior medical treatment before pegvisomant start, 65.9% had received somatostatin analogues and 18.6% dopamine agonists. Interestingly, 66.7% had received only pegvisomant at study start, while it was taken in association with dopamine agonists in 5.7%, with somatostatin analogues in 23.4% and with both types of agents in 3.8%. Mean IGF1 at baseline was 522 ng/ml. Conclusion Analysis of the baseline features of these patients treated with pegvisomant and reported in the ACROSTUDY database underscores the severity of the disease in this subset of the population of patients with acromegaly previously unresponsive to several medical, surgical or radiation treatment approaches.
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Affiliation(s)
- Thierry Brue
- Department of Endocrinology, Université de la Méditerranée and Centre de Référence des maladies rares d'origine hypophysaire, Hôpital de la Timone, Assistance Publique Hôpitaux de Marseille, France.
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Petersenn S, Buchfelder M, Gerbert B, Franz H, Quabbe HJ, Schulte HM, Grussendorf M, Reincke M. Age and sex as predictors of biochemical activity in acromegaly: analysis of 1485 patients from the German Acromegaly Register. Clin Endocrinol (Oxf) 2009; 71:400-5. [PMID: 19226273 DOI: 10.1111/j.1365-2265.2009.03547.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE We evaluated the German Acromegaly Register for clinical variables associated with the initial biochemical activity of patients with acromegaly. DESIGN Retrospective analysis of data in the registry. PATIENTS A total of 1485 patients with acromegaly (males 45.6%, females 54.4%) were treated in 42 German endocrine centres until November 2005. Linear regression models were used to estimate the influence of various parameters on biochemical activity. RESULTS Male patients with acromegaly were significantly younger at the time of diagnosis than female patients (41 vs. 47 years, P < 0.0001) and had significantly higher random GH levels than females (21 vs. 14 ng/ml, P < 0.005) and IGF-1 levels (773 vs. 679 ng/ml, P < 0.0001), respectively. Age at initial presentation turned out to be the most important independent risk factor associated with random GH levels, oral glucose tolerance test-suppressed GH levels, IGF-1 levels, body mass index (BMI), tumour size and prevalence of hypopituitarism. Sex was an independent risk factor for IGF-1 levels, BMI and prevalence of hypopituitarism. Tumour size was an independent risk factor for both GH and IGF-1 levels. CONCLUSIONS In summary, initial biochemical activity of acromegaly is influenced by patient's age and to a lesser degree by patient's sex. Male patients are on an average 6 years younger than females.
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Affiliation(s)
- S Petersenn
- Division of Endocrinology, Medical Center, University of Duisburg-Essen, Essen, Germany.
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Arita K, Hirano H, Yunoue S, Fujio S, Tominaga A, Sakoguchi T, Sugiyama K, Kurisu K. Treatment of elderly acromegalics. Endocr J 2008; 55:895-903. [PMID: 18552460 DOI: 10.1507/endocrj.k08e-117] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
We assessed the incidence of elderly patients in Japanese acromegalics and the characteristics of their clinical presentation. We also evaluated the safety and efficacy of transsphenoidal surgery (TSS) in this patient group. During the 28-year period from 1980 to 2007 we treated 290 patients with acromegaly at our hospitals. Of these, 9 (3.1%) were elderly, i.e. 70 years old or older. They comprised 0.7% of acromegalics treated during the first- and 4.5% of patients with acromegaly treated during the 2nd 14-year period. Before treatment, all manifested abnormal glucose tolerance; 6 had diabetes mellitus (DM), 6 presented with hypertension, and 2 had cardiovascular disease, malignant neoplasms, or hyperlipidemia. Of the 7 elderly acromegalics who underwent TSS none manifested surgical morbidity or new pituitary hormone deficiencies. Postoperatively, the nadir growth hormone (GH) level at the oral glucose tolerance test (OGTT) was under 1.0 ng/mL in 5 patients, insulin-like growth factor (IGF-1) levels normalized in 4. Glucose tolerance improved in all operated patients. Only 1 of 6 patients with preoperatively diagnosed DM continued to manifest DM post-treatment, anti-hypertensive drugs could be tapered in 3 of patients with preoperative hypertension. In conclusion, we found that there was a high incidence of abnormal glucose tolerance and hypertension in elderly acromegalics, that surgical treatment was effective and safe in this population, and that it was useful for the control of co-morbidities.
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Affiliation(s)
- Kazunori Arita
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Japan
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