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Campana C, Coopmans EC, Chiloiro S. Editorial: Treatment outcomes, comorbidities and impact of discordant biochemical values in acromegaly. Front Endocrinol (Lausanne) 2024; 15:1351350. [PMID: 38348419 PMCID: PMC10859404 DOI: 10.3389/fendo.2024.1351350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 01/15/2024] [Indexed: 02/15/2024] Open
Affiliation(s)
- Claudia Campana
- Endocrinology Unit, Department of Internal Medicine and Medical Specialties, School of Medical and Pharmaceutical Sciences, University of Genova, Genova, Italy
- Division of Endocrinology, Department of Internal Medicine, Erasmus Medical Center, Rotterdam, Netherlands
| | - Eva Christine Coopmans
- Division of Endocrinology, Department of Medicine, Leiden University Medical Center, Leiden, Netherlands
| | - Sabrina Chiloiro
- Pituitary Unit, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
- Endocrinology and Diabetes Unit, Università Cattolica del Sacro Cuore, Rome, Italy
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Kasuki L, Lamback E, Antunes X, Gadelha MR. Biomarkers of response to treatment in acromegaly. Expert Rev Endocrinol Metab 2024; 19:71-80. [PMID: 38078447 DOI: 10.1080/17446651.2023.2293107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 12/06/2023] [Indexed: 01/03/2024]
Abstract
INTRODUCTION Medical treatment of acromegaly is based in a `trial and error` approach. First-generation somatostatin receptor ligands (fg-SRL) are prescribed as first-line medical therapy to the vast majority of patients, despite lack of disease control in approximately 60% of patients. However, other drugs used in acromegaly treatment are available (cabergoline, pasireotide and pegvisomant). AREAS COVERED In this article, we review and discuss the biomarkers of response to medical treatment in acromegaly. EXPERT OPINION Biomarkers for fg-SRL that can already be applied in clinical practice are: gender, age, pretreatment GH and IGF-I levels, cytokeratin granulation pattern, and the expression of somatostatin receptor type 2. Using biomarkers of response could guide treatment towards precision medicine with greater efficacy and lower costs.
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Affiliation(s)
- Leandro Kasuki
- Neuroendocrinology Research Center/Endocrinology Division, Medical School and Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
- Neuroendocrinology Division, Instituto Estadual do Cérebro Paulo Niemeyer, Secretaria Estadual de Saúde, Rio de Janeiro, Brazil
- Endocrinology Division, Hospital Federal de Bonsucesso, Rio de Janeiro, Brazil
| | - Elisa Lamback
- Neuroendocrinology Research Center/Endocrinology Division, Medical School and Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
- Neuroendocrinology Division, Instituto Estadual do Cérebro Paulo Niemeyer, Secretaria Estadual de Saúde, Rio de Janeiro, Brazil
- Neuropathology and Molecular Genetics Laboratory, Instituto Estadual do Cérebro Paulo Niemeyer, Secretaria Estadual de Saúde, Rio de Janeiro, Brazil
| | - Ximene Antunes
- Neuroendocrinology Research Center/Endocrinology Division, Medical School and Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Mônica R Gadelha
- Neuroendocrinology Research Center/Endocrinology Division, Medical School and Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
- Neuroendocrinology Division, Instituto Estadual do Cérebro Paulo Niemeyer, Secretaria Estadual de Saúde, Rio de Janeiro, Brazil
- Neuropathology and Molecular Genetics Laboratory, Instituto Estadual do Cérebro Paulo Niemeyer, Secretaria Estadual de Saúde, Rio de Janeiro, Brazil
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Marques-Pamies M, Gil J, Valassi E, Hernández M, Biagetti B, Giménez-Palop O, Martínez S, Carrato C, Pons L, Villar-Taibo R, Araujo-Castro M, Blanco C, Simón I, Simó-Servat A, Xifra G, Vázquez F, Pavón I, García-Centeno R, Zavala R, Hanzu FA, Mora M, Aulinas A, Vilarrasa N, Librizzi S, Calatayud M, de Miguel P, Alvarez-Escola C, Picó A, Sampedro M, Salinas I, Fajardo-Montañana C, Cámara R, Bernabéu I, Jordà M, Webb SM, Marazuela M, Puig-Domingo M. Revisiting the usefulness of the short acute octreotide test to predict treatment outcomes in acromegaly. Front Endocrinol (Lausanne) 2023; 14:1269787. [PMID: 38027102 PMCID: PMC10654626 DOI: 10.3389/fendo.2023.1269787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 10/11/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction We previously described that a short version of the acute octreotide test (sAOT) can predict the response to first-generation somatostatin receptor ligands (SRLs) in patients with acromegaly. We have prospectively reassessed the sAOT in patients from the ACROFAST study using current ultra-sensitive GH assays. We also studied the correlation of sAOT with tumor expression of E-cadherin and somatostatin receptor 2 (SSTR2) . Methods A total of 47 patients treated with SRLs for 6 months were evaluated with the sAOT at diagnosis and correlated with SRLs' response. Those patients whose IGF1 decreased to <3SDS from normal value were considered responders and those whose IGF1 was ≥3SDS, were considered non-responders. The 2 hours GH value (GH2h) after s.c. administration of 100 mcg of octreotide was used to define predictive cutoffs. E-cadherin and SSTR2 immunostaining in somatotropinoma tissue were investigated in 24/47 and 18/47 patients, respectively. Results In all, 30 patients were responders and 17 were non-responders. GH2h was 0.68 (0.25-1.98) ng/mL in responders vs 2.35 (1.59-9.37) ng/mL in non-responders (p<0.001). GH2h = 1.4ng/mL showed the highest ability to identify responders (accuracy of 81%, sensitivity of 73.3%, and specificity of 94.1%). GH2h = 4.3ng/mL was the best cutoff for non-response prediction (accuracy of 74%, sensitivity of 35.3%, and specificity of 96.7%). Patients with E-cadherin-positive tumors showed a lower GH2h than those with E-cadherin-negative tumors [0.9 (0.3-2.1) vs 3.3 (1.5-12.1) ng/mL; p<0.01], and patients with positive E-cadherin presented a higher score of SSTR2 (7.5 ± 4.2 vs 3.3 ± 2.1; p=0.01). Conclusion The sAOT is a good predictor tool for assessing response to SRLs and correlates with tumor E-cadherin and SSTR2 expression. Thus, it can be useful in clinical practice for therapeutic decision-making in patients with acromegaly.
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Affiliation(s)
| | - Joan Gil
- Endocrine Research Unit, Germans Trias i Pujol Research Institute (IGTP), Badalona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBER-ER, Unidad 747), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
| | - Elena Valassi
- Endocrine Research Unit, Germans Trias i Pujol Research Institute (IGTP), Badalona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBER-ER, Unidad 747), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
- Department of Endocrinology and Nutrition, Germans Trias i Pujol University Hospital, Badalona, Spain
| | - Marta Hernández
- Department of Endocrinology and Nutrition, Arnau de Vilanova University Hospital, Lleida, Spain
- Endocrine Research Unit, Lleida Institute for Biomedical Research Dr. Pifarré Foundation (IRBLleida), Lleida, Spain
| | - Betina Biagetti
- Department of Endocrinology and Nutrition, Vall Hebron University Hospital, Barcelona, Spain
| | - Olga Giménez-Palop
- Department of Endocrinology and Nutrition, Parc Taulí University Hospital, Sabadell, Spain
| | - Silvia Martínez
- Department Hormonal Laboratory, Germans Trias i Pujol University Hospital, Badalona, Spain
| | - Cristina Carrato
- Department of Pathology, Germans Trias i Pujol University Hospital, Badalona, Spain
| | - Laura Pons
- Department of Pathology, Germans Trias i Pujol University Hospital, Badalona, Spain
| | - Rocío Villar-Taibo
- Department of Endocrinology and Nutrition, Clínico de Santiago University Hospital, Santiago de Compostela, Spain
| | - Marta Araujo-Castro
- Department of Endocrinology and Nutrition, Ramón y Cajal University Hospital, Madrid, Spain
| | - Concepción Blanco
- Department of Endocrinology and Nutrition, Príncipe de Asturias University Hospital, Madrid, Spain
| | - Inmaculada Simón
- Department of Endocrinology and Nutrition, Joan XXIII University Hospital, Tarragona, Spain
| | - Andreu Simó-Servat
- Department of Endocrinology and Nutrition, Mutua de Terrassa University Hospital, Terrassa, Spain
| | - Gemma Xifra
- Department of Endocrinology and Nutrition, Josep Trueta University Hospital, Girona, Spain
| | - Federico Vázquez
- Department of Endocrinology and Nutrition, Germans Trias i Pujol University Hospital, Badalona, Spain
| | - Isabel Pavón
- Department of Endocrinology and Nutrition, Getafe University Hospital, Madrid, Spain
| | - Rogelio García-Centeno
- Department of Endocrinology and Nutrition, Gregorio Marañón University Hospital, Madrid, Spain
| | - Roxana Zavala
- Department of Endocrinology and Nutrition, Joan XXIII University Hospital, Tarragona, Spain
| | - Felicia Alexandra Hanzu
- Department of Endocrinology and Nutrition, Hospital Clinic University Hospital, Barcelona, Spain
- Endocrine Research Unit, Institut d’Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Mireia Mora
- Department of Endocrinology and Nutrition, Hospital Clinic University Hospital, Barcelona, Spain
- Endocrine Research Unit, Institut d’Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Anna Aulinas
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBER-ER, Unidad 747), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
- Department of Endocrinology and Nutrition, Hospital Sant Pau, Barcelona, Spain
- Universitat Autònoma de Barcelona (UAB), Departament de Medicina, Barcelona, Spain
| | - Nuria Vilarrasa
- Department of Endocrinology and Nutrition, Bellvitge University Hospital, Bellvitge, Spain
- Endocrine Research Unit, Institut d’Investigació Biomèdica de Bellvitge (IDIBELL), Bellvitge, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Soledad Librizzi
- Department of Endocrinology and Nutrition, 12 de Octubre University Hospital, Madrid, Spain
| | - María Calatayud
- Department of Endocrinology and Nutrition, 12 de Octubre University Hospital, Madrid, Spain
| | - Paz de Miguel
- Department of Endocrinology and Nutrition, Clínico San Carlos University Hospital, Madrid, Spain
| | | | - Antonio Picó
- Department of Endocrinology and Nutrition, General University Hospital Dr Balmis, Miguel Hernández University, Alicante, Spain
- Endocrine Research Unit, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
| | - Miguel Sampedro
- Department of Endocrinology and Nutrition, La Princesa University Hospital, Madrid, Spain
| | - Isabel Salinas
- Department of Endocrinology and Nutrition, Germans Trias i Pujol University Hospital, Badalona, Spain
| | | | - Rosa Cámara
- Department of Endocrinology and Nutrition, La Fe University Hospital, Valencia, Spain
| | - Ignacio Bernabéu
- Department of Endocrinology and Nutrition, Clínico de Santiago University Hospital, Santiago de Compostela, Spain
| | - Mireia Jordà
- Endocrine Research Unit, Germans Trias i Pujol Research Institute (IGTP), Badalona, Spain
| | - Susan M. Webb
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBER-ER, Unidad 747), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
- Department of Endocrinology and Nutrition, Hospital Sant Pau, Barcelona, Spain
- Universitat Autònoma de Barcelona (UAB), Departament de Medicina, Barcelona, Spain
| | - Mónica Marazuela
- Department of Endocrinology and Nutrition, La Princesa University Hospital, Madrid, Spain
| | - Manel Puig-Domingo
- Endocrine Research Unit, Germans Trias i Pujol Research Institute (IGTP), Badalona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBER-ER, Unidad 747), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
- Department of Endocrinology and Nutrition, Germans Trias i Pujol University Hospital, Badalona, Spain
- Universitat Autònoma de Barcelona (UAB), Departament de Medicina, Barcelona, Spain
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Ruiz S, Gil J, Biagetti B, Venegas E, Cámara R, Garcia-Centeno R, Gálvez MÁ, Picó A, Maraver S, González I, Abellán P, Trincado P, Herrera M, Olvera P, Xifra G, Bernabeu I, Serra-Soler G, Azriel S, García L, Carvalho D, Jordà M, Valassi E, Puig J, Puig-Domingo M. Magnetic resonance imaging as a predictor of therapeutic response to pasireotide in acromegaly. Clin Endocrinol (Oxf) 2023; 99:378-385. [PMID: 37421211 DOI: 10.1111/cen.14946] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 06/26/2023] [Accepted: 06/28/2023] [Indexed: 07/10/2023]
Abstract
OBJECTIVE Hyperintensity signal in T2-weighted magnetic resonance imaging (MRI) has been related to better therapeutic response during pasireotide treatment in acromegaly. The aim of the study was to evaluate T2 MRI signal intensity and its relation with pasireotide therapeutic effectiveness in real-life clinical practice. DESIGN, PATIENTS AND MEASUREMENTS Retrospective multicentre study including acromegaly patients treated with pasireotide. Adenoma T2-weighted MRI signal at diagnosis was qualitatively classified as iso-hyperintense or hypointense. Insulin-like growth factor (IGF-I), growth hormone (GH) and tumour volume reduction were assessed after 6 and 12 months of treatment and its effectiveness evaluated according to baseline MRI signal. Hormonal response was considered 'complete' when normalization of IGF-I levels was achieved. Significant tumour shrinkage was defined as a volume reduction of ≥25% from baseline. RESULTS Eighty-one patients were included (48% women, 50 ± 1.5 years); 93% had previously received somatostatin receptor ligands (SRLs) treatment. MRI signal was hypointense in 25 (31%) and hyperintense in 56 (69%) cases. At 12 months of follow-up, 42/73 cases (58%) showed normalization of IGF-I and 37% both GH and IGF-I. MRI signal intensity was not associated with hormonal control. 19/51 cases (37%) presented a significant tumour volume shrinkage, 16 (41%) from the hyperintense group and 3 (25%) from the hypointense. CONCLUSIONS T2-signal hyperintensity was more frequently observed in pasireotide treated patients. Almost 60% of SRLs resistant patients showed a complete normalization of IGF-I after 1 year of pasireotide treatment, regardless of the MRI signal. There was also no difference in the percentage tumour shrinkage over basal residual volume between the two groups.
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Affiliation(s)
- Sabina Ruiz
- Germans Trias i i Pujol Research Institute and Hospital, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Joan Gil
- Germans Trias i i Pujol Research Institute and Hospital, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Betina Biagetti
- Servei d'Endocrinología i Nutrició, Hospital Universitari Vall d'Hebrón, Barcelona, Spain
| | - Eva Venegas
- Servicio de Endocrinología y Nutrición, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Rosa Cámara
- Servicio de Endocrinología y Nutrición, Hospital Universitario La Fe, Valencia, Spain
| | - Rogelio Garcia-Centeno
- Servicio de Endocrinología y Nutrición, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - María-Ángeles Gálvez
- Servicio de Endocrinología y Nutrición, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Antonio Picó
- Servicio de Endocrinología y Nutrición, Hospital General Universitario de Alicante, Alicante, Spain
| | - Silvia Maraver
- Servicio de Endocrinología y Nutrición, Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - Inmaculada González
- Servicio de Endocrinología y Nutrición, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Pablo Abellán
- Servicio de Endocrinología y Nutrición, Hospital General Universitario de Castellón, Castellón de la Plana, Spain
| | - Pablo Trincado
- Servicio de Endocrinología y Nutrición, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Mayte Herrera
- Servicio de Endocrinología y Nutrición, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Pilar Olvera
- Servicio de Endocrinología y Nutrición, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Gemma Xifra
- Servei d'Endocrinologia i Nutrició, Hospital Universitari Josep Trueta, Girona, Spain
| | - Ignacio Bernabeu
- Servicio de Endocrinología y Nutrición, Complejo Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Guillermo Serra-Soler
- Servicio de Endocrinología y Nutrición, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - Sharona Azriel
- Servicio de Endocrinología y Nutrición, Hospital Universitario Infanta Sofía, Madrid, Spain
| | - Lourdes García
- Servicio de Endocrinología y Nutrición, Hospital Universitario de Jerez, Cádiz, Spain
| | - Davide Carvalho
- Servicio de Endocrinología, Diabetes y Metabolismo, Centro Hospitalar Universitário de São João, FMUP, i3s, Porto, Portugal
| | - Mireia Jordà
- Germans Trias i i Pujol Research Institute and Hospital, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Elena Valassi
- Germans Trias i i Pujol Research Institute and Hospital, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Josep Puig
- Centre de Medicina Comparada i Bioimatge, IGTP, Badalona, Spain
- Servei de Radiologia, Hospital Universitari Josep Trueta, IDIBGi, Girona, Spain
| | - Manel Puig-Domingo
- Germans Trias i i Pujol Research Institute and Hospital, Universitat Autònoma de Barcelona, Badalona, Spain
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Fleseriu M, Barkan A, Brue T, Duquesne E, Houchard A, del Pilar Schneider M, Ribeiro-Oliveira A, Melmed S. Treatment Patterns, Adherence, Persistence, and Health Care Resource Utilization in Acromegaly: A Real-World Analysis. J Endocr Soc 2023; 7:bvad104. [PMID: 37705695 PMCID: PMC10496868 DOI: 10.1210/jendso/bvad104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Indexed: 09/15/2023] Open
Abstract
Context Treatment of acromegaly is multimodal for many patients, and medical treatments include somatostatin receptor ligands (SRLs), dopamine agonists (DAs), and growth hormone receptor antagonists (GHRAs). However, recent real-world evidence on treatment patterns for patients with acromegaly is limited. Objective This study evaluated medication usage, treatment changes, adherence, persistence, comorbidities, and health care resource utilization using deidentified data from MarketScan, a US claims database. Methods Eligible patients (n = 882) were those receiving monotherapy or combination therapy for ≥90 days without treatment gaps. Results Mean age at diagnosis was 48.6 years; 50.1% of patients were female. Over half (59.4%) had 1 line of treatment (LOT); 23.1% had 2 LOTs; 17.5% had at least 3 LOTs. Most patients (94.6%) initiated treatment with monotherapies. The most common first-line monotherapy treatments were cabergoline (DA, 36.8%), octreotide long-acting release (first-generation SRL, 29.5%), and lanreotide depot (first-generation SRL, 22.5%). Adherence for first-line treatments (proportion of days covered) was higher for first-generation SRLs (lanreotide depot: 0.8) compared with DAs (0.7). Treatment persistence (time between the first treatment record and a change in LOT/censoring) in LOT 1 was higher for GHRAs (24.8 months) and first-generation SRLs (20.0 months) compared with DAs (14.4 months). Female patients and those diagnosed at a younger age were more likely to have shorter treatment persistence. The most prevalent comorbidities were hyperlipidemia, essential hypertension, and sleep apnea. Conclusion Patients with more comorbidities had more health care visits during the first year after diagnosis, suggesting increased disease burden. Real-world evidence on treatment patterns provides insights into recommendations for individualized therapy.
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Affiliation(s)
- Maria Fleseriu
- Pituitary Center, Departments of Medicine and Neurological Surgery, Oregon Health & Science University, Portland, OR 97239, USA
| | - Ariel Barkan
- A. Alfred Taubman Health Care Center, University of Michigan, Ann Arbor, MI 48109, USA
| | - Thierry Brue
- Faculté de Médecine, Aix-Marseille University, Marseille 13385, France
| | | | - Aude Houchard
- Ipsen, HEOR Oncology Department, Boulogne–Billancourt 92100, France
| | | | | | - Shlomo Melmed
- Pituitary Center, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
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Störmann S, Schilbach K. Delving into Acromegaly. J Clin Med 2023; 12:jcm12041654. [PMID: 36836189 PMCID: PMC9966199 DOI: 10.3390/jcm12041654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 02/15/2023] [Indexed: 02/22/2023] Open
Abstract
Acromegaly is a rare and disabling disease with some distinct and striking clinical features that have fascinated (and frightened) laypeople and medical experts alike throughout history [...].
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Bianchi A, Chiloiro S, Giampietro A, Gaudino S, Calandrelli R, Mazzarella C, Caldarella C, Rigante M, Gessi M, Lauretti L, De Marinis L, Olivi A, Pontecorvi A, Doglietto F. Multidisciplinary management of difficult/aggressive growth-hormone pituitary neuro-endocrine tumors. Front Endocrinol (Lausanne) 2023; 14:1123267. [PMID: 37206441 PMCID: PMC10189777 DOI: 10.3389/fendo.2023.1123267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 03/13/2023] [Indexed: 05/21/2023] Open
Abstract
Growth Hormone-secreting adenomas exhibits variable biological behavior and heterogeneous natural history, ranging from small adenomas and mild disease, to invasive and aggressive neoplasms with more severe clinical picture. Patients not cured or controlled after neurosurgical and first-generation somatostatin receptor ligands (SRL) therapy could require multiple surgical, medical and/or radiation treatments to achieve disease control. To date, no clinical, laboratory, histopathological, or neuroradiological markers are able to define the aggressiveness or predict the disease prognosis in patients with acromegaly. Therefore, the management of these patients requires careful evaluation of laboratory assessments, diagnostic criteria, neuroradiology examinations, and neurosurgical approaches to choose an effective and patient-tailored medical therapy. A multidisciplinary approach is particularly useful in difficult/aggressive acromegaly to schedule multimodal treatment, which includes radiation therapy, chemotherapy with temozolomide and other, recent emerging treatments. Herein, we describe the role of the different members of the multidisciplinary team according to our personal experience; a flow-chart for the therapeutic approach of difficult/aggressive acromegaly patients is proposed.
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Affiliation(s)
- Antonio Bianchi
- Pituitary Unit, Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario Agostino Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
- Endocrinology and Diabetes Unit, Department of Medical and Surgical Translational Sciences, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Sabrina Chiloiro
- Pituitary Unit, Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario Agostino Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
- Endocrinology and Diabetes Unit, Department of Medical and Surgical Translational Sciences, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
- *Correspondence: Sabrina Chiloiro,
| | - Antonella Giampietro
- Pituitary Unit, Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario Agostino Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
- Endocrinology and Diabetes Unit, Department of Medical and Surgical Translational Sciences, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Simona Gaudino
- Radiology and Neuroradiology Unit, Department of Imaging, Radiation Therapy and Hematology, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Rosalinda Calandrelli
- Radiology and Neuroradiology Unit, Department of Imaging, Radiation Therapy and Hematology, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Ciro Mazzarella
- Radiation Therapy Unit, Department of Imaging, Radiation Therapy and Hematology, Fondazione Policlinico Universitario Agostino Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Carmelo Caldarella
- Nuclear Medicine Unit, Department of Imaging, Radiation Therapy and Hematology, Fondazione Policlinico Universitario Agostino Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Mario Rigante
- Department of Aging, Neurological, Orthopedic and Head-Neck Sciences, Fondazione Policlinico Universitario Agostino Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Marco Gessi
- Neuropathology Unit, Fondazione Policlinico Universitario Agostino Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
- Pathology Unit of Head and Neck, Lung and Endocrine Systems, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Liverana Lauretti
- Neurosurgery Unit, Department of Neurosciences, Fondazione Policlinico Universitario Agostino Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
- Neurosurgery Unit, Department of Neurosciences, Catholic University School of Medicine, Rome, Italy
| | - Laura De Marinis
- Pituitary Unit, Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario Agostino Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
- Endocrinology and Diabetes Unit, Department of Medical and Surgical Translational Sciences, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Alessandro Olivi
- Neurosurgery Unit, Department of Neurosciences, Fondazione Policlinico Universitario Agostino Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
- Neurosurgery Unit, Department of Neurosciences, Catholic University School of Medicine, Rome, Italy
| | - Alfredo Pontecorvi
- Pituitary Unit, Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario Agostino Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
- Endocrinology and Diabetes Unit, Department of Medical and Surgical Translational Sciences, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Francesco Doglietto
- Neurosurgery Unit, Department of Neurosciences, Fondazione Policlinico Universitario Agostino Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
- Neurosurgery Unit, Department of Neurosciences, Catholic University School of Medicine, Rome, Italy
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Abstract
Acromegaly is a systemic disease associated with increased morbidity and mortality that can be prevented with adequate disease control. Three modalities of treatment (surgery, medical treatment, and radiotherapy) are available; however, a significant proportion of patients still maintain disease activity despite treatment. Therefore, there is a need for innovations in the treatment of acromegaly that include changes in the current trial and error approach and the development of new drugs. In this review, we summarize the recent innovations in the treatment of acromegaly and address the future perspectives in this field.
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Affiliation(s)
- Leandro Kasuki
- Neuroendocrinology Research Center/Endocrinology Division, Medical School and Hospital Universitário Clementino Fraga Filho, Universidade Federal Do Rio de Janeiro, Rio de Janeiro, Brazil; Neuroendocrinology Division, Instituto Estadual Do Cérebro Paulo Niemeyer, Secretaria Estadual de Saúde, Rio de Janeiro, Brazil; Endocrinology Division, Hospital Federal de Bonsucesso, Rio de Janeiro, Brazil
| | - Mônica R Gadelha
- Neuroendocrinology Research Center/Endocrinology Division, Medical School and Hospital Universitário Clementino Fraga Filho, Universidade Federal Do Rio de Janeiro, Rio de Janeiro, Brazil; Neuroendocrinology Division, Instituto Estadual Do Cérebro Paulo Niemeyer, Secretaria Estadual de Saúde, Rio de Janeiro, Brazil; Neuropathology and Molecular Genetics Laboratory, Instituto Estadual Do Cérebro Paulo Niemeyer, Secretaria Estadual de Saúde, Rio de Janeiro, Brazil.
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9
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Popescu AD, Carsote M, Valea A, Nicola AG, Dascălu IT, Tircă T, Abdul-Razzak J, Țuculină MJ. Approach of Acromegaly during Pregnancy. Diagnostics (Basel) 2022; 12:diagnostics12112669. [PMID: 36359512 PMCID: PMC9689290 DOI: 10.3390/diagnostics12112669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 10/24/2022] [Accepted: 10/30/2022] [Indexed: 11/06/2022] Open
Abstract
Acromegaly-related sub/infertility, tidily related to suboptimal disease control (1/2 of cases), correlates with hyperprolactinemia (1/3 of patients), hypogonadotropic hypogonadism—mostly affecting the pituitary axis in hypopituitarism (10−80%), and negative effects of glucose profile (GP) anomalies (10−70%); thus, pregnancy is an exceptional event. Placental GH (Growth Hormone) increases from weeks 5−15 with a peak at week 37, stimulating liver IGF1 and inhibiting pituitary GH secreted by normal hypophysis, not by somatotropinoma. However, estrogens induce a GH resistance status, protecting the fetus form GH excess; thus a full-term, healthy pregnancy may be possible. This is a narrative review of acromegaly that approaches cardio-metabolic features (CMFs), somatotropinoma expansion (STE), management adjustment (MNA) and maternal-fetal outcomes (MFOs) during pregnancy. Based on our method (original, in extenso, English—published articles on PubMed, between January 2012 and September 2022), we identified 24 original papers—13 studies (3 to 141 acromegalic pregnancies per study), and 11 single cases reports (a total of 344 pregnancies and an additional prior unpublished report). With respect to maternal acromegaly, pregnancies are spontaneous or due to therapy for infertility (clomiphene, gonadotropins or GnRH) and, lately, assisted reproduction techniques (ARTs); there are no consistent data on pregnancies with paternal acromegaly. CMFs are the most important complications (7.7−50%), especially concerning worsening of HBP (including pre/eclampsia) and GP anomalies, including gestational diabetes mellitus (DM); the best predictor is the level of disease control at conception (IGF1), and, probably, family history of 2DM, and body mass index. STE occurs rarely (a rate of 0 to 9%); some of it symptoms are headache and visual field anomalies; it is treated with somatostatin analogues (SSAs) or alternatively dopamine agonists (DAs); lately, second trimester selective hypophysectomy has been used less, since pharmaco-therapy (PT) has proven safe. MNA: PT that, theoretically, needs to be stopped before conception—continued if there was STE or an inoperable tumor (no clear period of exposure, preferably, only first trimester). Most data are on octreotide > lanreotide, followed by DAs and pegvisomant, and there are none on pasireotide. Further follow-up is required: a prompt postpartum re-assessment of the mother’s disease; we only have a few data confirming the safety of SSAs during lactation and long-term normal growth and developmental of the newborn (a maximum of 15 years). MFO seem similar between PT + ve and PT − ve, regardless of PT duration; the additional risk is actually due to CMF. One study showed a 2-year median between hypophysectomy and pregnancy. Conclusion: Close surveillance of disease burden is required, particularly, concerning CMF; a personalized approach is useful; the level of statistical evidence is expected to expand due to recent progress in MNA and ART.
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Affiliation(s)
- Alexandru Dan Popescu
- Department of Endodontics, Faculty of Dental Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Mara Carsote
- Department of Endocrinology, Carol Davila University of Medicine and Pharmacy & C.I. Parhon National Institute of Endocrinology, 011683 Bucharest, Romania
- Correspondence: (M.C.); (A.V.); Tel.: +40-744851934 (M.C.)
| | - Ana Valea
- Department of Endocrinology, Iuliu Hatieganu University of Medicine and Pharmacy & Clinical County Hospital, 400012 Cluj-Napoca, Romania
- Correspondence: (M.C.); (A.V.); Tel.: +40-744851934 (M.C.)
| | - Andreea Gabriela Nicola
- Department of Oro-Dental Prevention, Faculty of Dental Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Ionela Teodora Dascălu
- Department of Orthodontics, Faculty of Dental Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Tiberiu Tircă
- Department of Oro-Dental Prevention, Faculty of Dental Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Jaqueline Abdul-Razzak
- Department of Infant Care–Pediatrics–Neonatology, Romania & Doctoral School, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Mihaela Jana Țuculină
- Department of Endodontics, Faculty of Dental Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
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10
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Fleseriu M, Langlois F, Lim DST, Varlamov EV, Melmed S. Acromegaly: pathogenesis, diagnosis, and management. Lancet Diabetes Endocrinol 2022; 10:804-826. [PMID: 36209758 DOI: 10.1016/s2213-8587(22)00244-3] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 08/01/2022] [Accepted: 08/09/2022] [Indexed: 11/23/2022]
Abstract
Growth hormone-secreting pituitary adenomas that cause acromegaly arise as monoclonal expansions of differentiated somatotroph cells and are usually sporadic. They are almost invariably benign, yet they can be locally invasive and show progressive growth despite treatment. Persistent excess of both growth hormone and its target hormone insulin-like growth factor 1 (IGF-1) results in a wide array of cardiovascular, respiratory, metabolic, musculoskeletal, neurological, and neoplastic comorbidities that might not be reversible with disease control. Normalisation of IGF-1 and growth hormone are the primary therapeutic aims; additional treatment goals include tumour shrinkage, relieving symptoms, managing complications, reducing excess morbidity, and improving quality of life. A multimodal approach with surgery, medical therapy, and (more rarely) radiation therapy is required to achieve these goals. In this Review, we examine the epidemiology, pathogenesis, diagnosis, complications, and treatment of acromegaly, with an emphasis on the importance of tailoring management strategies to each patient to optimise outcomes.
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Affiliation(s)
- Maria Fleseriu
- Department of Medicine (Division of Endocrinology, Diabetes and Clinical Nutrition) and Department of Neurological Surgery, and Pituitary Center, Oregon Health & Science University, Portland, OR, USA.
| | - Fabienne Langlois
- Division of Endocrinology, Department of Medicine, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada
| | | | - Elena V Varlamov
- Department of Medicine (Division of Endocrinology, Diabetes and Clinical Nutrition) and Department of Neurological Surgery, and Pituitary Center, Oregon Health & Science University, Portland, OR, USA
| | - Shlomo Melmed
- Department of Medicine and Pituitary Center, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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