A Consensus on the Diagnosis and Treatment of Acromegaly Comorbidities

An Update

Andrea Giustina; Ariel Barkan; Albert Beckers; Nienke Biermasz; Beverly M. K. Biller; Cesar Boguszewski; Marek Bolanowski; Vivien Bonert; Marcello D. Bronstein; Felipe F. Casanueva; David Clemmons; Annamaria Colao; Diego Ferone; Maria Fleseriu; Stefano Frara; Monica R. Gadelha; Ezio Ghigo; Mark Gurnell; Anthony P. Heaney; Ken Ho; Adriana Ioachimescu; Laurence Katznelson; Fahrettin Kelestimur; John Kopchick; Michal Krsek; Steven Lamberts; Marco Losa; Anton Luger; Pietro Maffei; Monica Marazuela; Gherardo Mazziotti; Moises Mercado; Pietro Mortini; Sebastian Neggers; Alberto M. Pereira; Stephan Petersenn; Manel Puig-Domingo; Roberto Salvatori; Ilan Shimon; Christian Strasburger; Stylianos Tsagarakis; A. J. van der Lely; John Wass; Maria Chiara Zatelli; Shlomo Melmed

Disclosures

J Clin Endocrinol Metab. 2020;105(4) 

In This Article

Abstract and Introduction

Abstract

Objective: The aim of the Acromegaly Consensus Group was to revise and update the consensus on diagnosis and treatment of acromegaly comorbidities last published in 2013.

Participants: The Consensus Group, convened by 11 Steering Committee members, consisted of 45 experts in the medical and surgical management of acromegaly. The authors received no corporate funding or remuneration.

Evidence: This evidence-based consensus was developed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system to describe both the strength of recommendations and the quality of evidence following critical discussion of the current literature on the diagnosis and treatment of acromegaly comorbidities.

Consensus Process: Acromegaly Consensus Group participants conducted comprehensive literature searches for English-language papers on selected topics, reviewed brief presentations on each topic, and discussed current practice and recommendations in breakout groups. Consensus recommendations were developed based on all presentations and discussions. Members of the Scientific Committee graded the quality of the supporting evidence and the consensus recommendations using the GRADE system.

Conclusions: Evidence-based approach consensus recommendations address important clinical issues regarding multidisciplinary management of acromegaly-related cardiovascular, endocrine, metabolic, and oncologic comorbidities, sleep apnea, and bone and joint disorders and their sequelae, as well as their effects on quality of life and mortality.

Introduction

Excess levels of circulating GH and IGF-I in acromegaly have deleterious effects on a wide range of tissues and physiologic processes.[1,2] Patients commonly experience abnormal growth of bone and soft tissue[3,4] and have dysregulated glucose metabolism[5,6] with increased risk for cardiovascular disease,[7] all of which may affect mortality risk.[8] Treatment of patients with acromegaly is aimed at controlling excess GH and/or IGF-I levels, but signs and symptoms of the disease often persist despite achievement of biochemical control.[1,9,10] The diagnosis and optimal management of acromegaly comorbidities is critical to ensuring the best long-term outcome for this chronic illness.

The Acromegaly Consensus Group published the first set of recommendations on diagnosis and treatment of disease complications in 2003[11] and updated them in 2013.[12] In concert with development of new disease management protocols,[9] and the conceptualization of the Pituitary Tumor Center of Excellence,[13] investigators have increasingly been focusing on defining and optimizing management strategies for acromegaly comorbidities and disease-related sequelae. In June 2018, 45 experts in acromegaly management reviewed the literature and critically assessed new research findings and changes in clinical practice standards and clinical opinion since the 2013 consensus publication. Discussions focused on: cardiovascular, endocrine, metabolic, and oncologic comorbidities, sleep apnea, and bone and joint disorders, as well as the impact of these disease sequelae on quality of life (QoL) and mortality. Updated consensus recommendations on diagnosis and treatment of acromegaly comorbidities were graded using the Grading of Recommendations Assessment, Development and Evaluation system (GRADE; Table 1)[14,15] and key consensus recommendations are presented in Table 2.

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