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Experts have presented a new set of consensus recommendations for the clinical management of acromegaly, which were published in Nature Reviews Endocrinology. The consensus provides updated drug recommendations and clinical practices, with an emphasis on the effect of somatostatin receptor ligands and growth hormone receptor and dopamine antagonists on patients’ outcomes.
This consensus was formulated by a team of 37 experts in acromegaly. They recommend that patients receive treatment at excellent centers for pituitary tumor care and that the pituitary adenoma should be resected by an experienced neurosurgeon for the best chance of cure. Medical therapy is a suitable option for individuals whose condition has either not improved with surgery or is not suited for surgery.
If the condition persists post-surgery, a long-acting somatostatin receptor ligand is a suitable option for first-line therapy. For patients with residual tumors for which resection is not suitable and who have not achieved control on first-generation somatostatin receptor ligands, clinicians should consider switching to pasireotide long release. Pegvisomant is a recommended alternative for patients with pre-existing impaired glucose metabolism for whom first-generation somatostatin receptor ligands were not effective.
Literature for this consensus was published between 2013 and 2017 and collected from PubMed. The participants presented each topic to the group as a whole. They were then subdivided to discuss the topic and develop recommendations, which were then voted upon individually. The scientific committee graded evidence supporting each recommendation, after which the recommendations themselves were graded based on the value of the evidence.
The study researchers concluded that “[our] recommendations for management of acromegaly have markedly changed since the previous consensus published in 2014. With the availability of pasireotide [long-acting release], patients now have more treatment options and are more likely to achieve biochemical control. At the same time, clinicians should be vigilant about tailoring treatment approaches to account for the full clinical disease spectrum, taking into account biochemical control rates as well as tumour profile and glucose metabolism.”
Reference
Melmed S, Bronstein MD, Chanson P, et al. A Consensus Statement on acromegaly therapeutic outcomes.. Nat Rev Endocrinol. 2018; 14(9):552-561.
