Keywords
Clinical Diagnosis
Pituitary Adenoma
Pituitary Function Tests
Diagnostic Imaging
Therapeutics
Follow Up Care
How to Cite
Abstract
Background: Acromegaly is a rare disease in the general population and usually has an insidious clinical evolution, which poses a challenge to diagnose the patient based on clinical suspicion and subsequent confirmation with diagnostic aids. The highest percentage of patients have acromegaly secondary to growth hormone-secreting pituitary tumors and, consequently, effective treatment should be aimed at achieving biochemical control and reducing tumor mass. Finally, patient follow-up is key to achieving control of the disease and detecting associated comorbidities.
Objective: To define criteria for the diagnosis, treatment and follow-up of acromegaly in Colombian patients.
Materials and methods: A modified Delphi-type consensus was carried out, with the opinion of 10 experts in the management of patients with acromegaly (endocrinologists and neurosurgeons) and a developer group. From the analysis and discussion of the results, the recommendations were presented in the different sections.
Results: Recommendations were obtained about the follow-up of the Colombian patient with acromegaly and about the approach to the patient from the local health system, clinical suspicion, biochemical and imaging diagnosis, treatment by surgical intervention, pharmacological treatment and radiotherapy.
Conclusions: In Colombia, it is important to strengthen medical knowledge in the correct diagnosis, management and follow-up of patients with acromegaly to make an early detection of the disease and reduce the progression of associated comorbidities.
References
Tovar H, Rojas W. Experiencia en acromegalia en el Hospital de San José Reporte de serie de casos 1990-2007. Acta Medica Colomb. 35(2):48-52. https://doi.org/10.36104/amc.2010.1568
Abreu-Rosario C, Cadena-Obando D, Vergara-López A, Espinosa de los Monteros-Sánchez AL, Portocarrero-Ortiz L, Gómez Romero P, et al. Tercer Consenso Nacional de Acromegalia: recomendaciones para su diagnóstico, tratamiento y seguimiento. Rev Mex Endocrinol Metab Nutr. 2021 ag. 11;8(91):5991. https://doi.org/10.24875/RME.M21000007
Muhammad A, van der Lely AJ, Neggers SJ. Review of current and emerging treatment options in acromegaly. Neth J Med. 2015 oct.;73(8):362-7.
Fleseriu M, Biller BM, Freda PU, Gadelha MR, Giustina A, Katznelson L, et al. A Pituitary Society update to acromegaly management guidelines. Pituitary. 2021 febr.;24(1):1-13. https://doi.org/10.1007/s11102-020-01091-7
Secretaria de Ciência, Tecnologia e Insumos Estratégicos. Protocolo Clínico e Diretrizes Terapêuticas da Acromegalia. Brasilia: Ministério da Saúde; 2019.
Humphrey-Murto S, Varpio L, Wood TJ, Gonsalves C, Ufholz LA, Mascioli K, et al. The Use of the Delphi and Other Consensus Group Methods in Medical Education Research: A Review. Acad Med. 2017 oct.;92(10):1491-8. https://doi.org/10.1097/ACM.0000000000001812
Jamieson S. Likert scales: how to (ab)use them. Med Educ. 2004 dic.;38(12):1217-8. https://doi.org/10.1111/j.1365-2929.2004.02012.x
Abreu A, Tovar AP, Castellanos R, Valenzuela A, Giraldo CM, Pinedo AC, et al. Challenges in the diagnosis and management of acromegaly: a focus on comorbidities. Pituitary. 2016 ag.;19(4):448-57. https://doi.org/10.1007/s11102-016-0725-2
Clemmons DR. Consensus statement on the standardization and evaluation of growth hormone and insulin-like growth factor assays. Clin Chem. 2011;57(4):555-9. https://doi.org/10.1373/clinchem.2010.150631
Abosch A, Tyrrell JB, Lamborn KR, Hannegan LT, Applebury CB, Wilson CB. Transsphenoidal microsurgery for growth hormone-secreting pituitary adenomas: initial outcome and long-term results. J Clin Endocrinol Metab. 1998;83(10):3411-8. https://doi.org/10.1210/jcem.83.10.5111
Giustina A, Chanson P, Kleinberg D, Bronstein MD, Clemmons DR, Klibanski A, et al. Acromegaly Consensus Group. Expert consensus document: A consensus on the medical treatment of acromegaly. Nat Rev Endocrinol. 2014;10(4):243-8. https://doi.org/10.1038/nrendo.2014.21
Melmed S, Bronstein MD, Chanson P, Klibanski A, Casanueva FF, Wass JA, et al. A Consensus Statement on acromegaly therapeutic outcomes. Nat Rev Endocrinol. 2018 sept.;14(9):552-61. https://doi.org/10.1038/s41574-018-0058-5
Sandret L, Maison P, Chanson P. Place of cabergoline in acromegaly: a meta-analysis. J Clin Endocrinol Metab. 2011;96(5):1327-35. https://doi.org/10.1210/jc.2010-2443
Basavilbaso NX, Ballarino MC, Bruera D, Bruno OD, Chervin AB, Danilowicz K, et al. Pegvisomant in acromegaly: a multicenter real-life study in Argentina. Arch Endocrinol Metab. 2019 ag. 14;63(4):320-7. https://doi.org/10.20945/2359-3997000000160
Bolanowski M, Zgliczy?ski W, Sowi?ski J, Ba?dys-Waligórska A, Bednarek-Tupikowska G, Witek P, et al. Therapeutic effect of presurgical treatment with longacting octreotide (Sandostatin® LAR®) in patients with acromegaly. Endokrynol Pol. 2020;71(4):285-91. https://doi.org/10.5603/EP.a2020.0050
Agrawal N, Ioachimescu AG. Prognostic factors of biochemical remission after transsphenoidal surgery for acromegaly: a structured review. Pituitary. 2020 oct.;23(5):582-94. https://doi.org/10.1007/s11102-020-01063-x
Aydin S, Ozoner B, Sahin S, Alizada O, Comunoglu N, Oz B, et al. A follow-up study on outcomes of endoscopic transsphenoidal approach for acromegaly. Clin Neurol Neurosurg. 2020 nov.; 198:106201. https://doi.org/10.1016/j.clineuro.2020.106201
Castellanos-Bueno R, Abreu-Lomba A, Buitrago-Gómez N, Patiño-Arboleda M, Pantoja-Guerrero D, Valenzuela-Rincón A, et al. Clinical and epidemiological characteristics, morbidity and treatment based on the registry of acromegalic patients in Colombia: RAPACO. Growth Horm IGF Res. 2021 oct.;60-1:101425. https://doi.org/10.1016/j.ghir.2021.101425
Galvis-Franco W, Franco H, Abreu-Lomba A, Velez-Alvarez C. Manifestaciones dermatológicas y enfermedades concomitantes en pacientes con acromegalia o gigantismo. Rev Asoc Colomb Dermatol. 2019;27(2):98-107. https://doi.org/10.29176/2590843X.982
Ceballos-Delgado Y, Carvajal R, Buitrago-Gómez N, Delgado A, Rivera A, Osorio V, et al. Efectividad de la terapia con análogos de somatostatina sobre el control de pacientes con acromegalia en un centro de alta complejidad, Cali-Colombia. RevACE. 2021 nov. 2;8(1). https://doi.org/10.53853/encr.8.1.661
Sandret L, Maison P, Chanson P. Place of Cabergoline in Acromegaly: A Meta-Analysis. J Clin Endocrinol Metab. 2011 my. 1;96(5):1327-35. https://doi.org/10.1210/jc.2010-2443
Lavrentaki A, Paluzzi A, Wass JA, Karavitaki N. Epidemiology of acromegaly: review of population studies. Pituitary. 2017 febr.;20(1):4-9. https://doi.org/10.1007/s11102-016-0754-x
Katznelson L, Laws ER, Melmed S, Molitch ME, Murad MH, Utz A, et al. Acromegaly: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2014 nov.;99(11):3933-51. https://doi.org/10.1210/jc.2014-2700
Toward Optimized Practice (TOP) Endocrine Working Group. Laboratory endocrine testing: acromegaly clinical practice guideline. 2008. https://actt.albertadoctors.org/CPGs/Lists/CPGDocumentList/acromegaly-guideline.pdf
American Association of Clinical Endocrinologists. Medical Guidelines for Clinical Practice for the Diagnosis and Treatment of Acromegaly-2011 Update. Endocrine Practice. 2011 jul.;17:1-44. https://doi.org/10.4158/EP.17.S4.1
Colao A, Bronstein MD, Brue T, De Marinis L, Fleseriu M, Guitelman M, et al. Pasireotide for acromegaly: long-term outcomes from an extension to the Phase III PAOLA study. Eur J Endocrinol. 2020 jun.;182(6):583. https://doi.org/10.1530/EJE-19-0762
Mercado M, Abreu C, Vergara-López A, González-Virla B, Espinosa-de-los-Monteros AL, Sosa-Eroza E, et al. Surgical and Pharmacological Outcomes in Acromegaly: Real-Life Data From the Mexican Acromegaly Registry. J Clin Endocrinol Metab. 2020 dic. 1;105(12):e4567-76. https://doi.org/10.1210/clinem/dgaa664
Oldfield EH, Jane JA, Thorner MO, Pledger CL, Sheehan JP, Vance ML. Correlation between GH and IGF-1 during treatment for acromegaly. JNS. 2016 nov.;126(6):1959-66. https://doi.org/10.3171/2016.8.JNS161123
Sims-Williams HP, Rajapaksa K, Sinha S, Radatz M, Walton L, Yianni J, et al. Radiosurgery as primary management for acromegaly. Clin Endocrinol. 2019 en.;90(1):114-21. https://doi.org/10.1111/cen.13870
Antunes X, Ventura N, Camilo GB, Wildemberg LE, Guasti A, Pereira PJ, et al. Predictors of surgical outcome and early criteria of remission in acromegaly. Endocrine. 2018 jun.;60(3):415-22. https://doi.org/10.1007/s12020-018-1590-8
Donegan DM, Iñiguez-Ariza N, Sharma A, Nippoldt T, Young W, Van Gompel J, et al. Necessity of Multimodal Treatment of Acromegaly and Outcomes. Endocr Pract. 2018 jul.;24(7):668-76. https://doi.org/10.4158/EP-2018-0040
Basavilbaso NX, Ballarino MC, Bruera D, Bruno OD, Chervin AB, Danilowicz K, et al. Pegvisomant in acromegaly: a multicenter real-life study in Argentina. Arch Endocrinol Metab. 2019 ag. 14;63(4):320-7. https://doi.org/10.20945/2359-3997000000160
Apaydin T, Ozkaya HM, Keskin FE, Haliloglu OA, Karababa K, Erdem S, et al. Daily life reflections of acromegaly guidelines. J Endocrinol Invest. 2017 mzo.;40(3):323-30. https://doi.org/10.1007/s40618-016-0567-9
Boguszewski CL, Huayllas MK, Vilar L, Naves LA, Ribeiro-Oliveira A, Soares BS, et al. Brazilian multicenter study on pegvisomant treatment in acromegaly. Arch Endocrinol Metab. 2019 jul. 11;63(4). https://doi.org/10.20945/2359-3997000000159
Portocarrero-Ortiz LA, Vergara-López A, Vidrio-Velázquez M, Uribe-Diaz AM, García-Domínguez A, Reza-Albarrán AA, et al. The Mexican Acromegaly Registry: Clinical and Biochemical Characteristics at Diagnosis and Therapeutic Outcomes. J Clin Endocrinol Metab. 2016 nov. 1;101(11):3997-4004. https://doi.org/10.1210/jc.2016-1937
Nishioka H, Fukuhara N, Yamaguchi-Okada M, Takeshita A, Takeuchi Y, Yamada S. Pitfalls in early biochemical evaluation after transsphenoidal surgery in patients with acromegaly. Endocr J. 2017;64(11):1073-8. https://doi.org/10.1507/endocrj.EJ17-0261
Ding D, Mehta GU, Patibandla MR, Lee CC, Liscak R, Kano H, et al. Stereotactic Radiosurgery for Acromegaly: An International Multicenter Retrospective Cohort Study. Neurosurg. 2019 mzo.;84(3):717-25. https://doi.org/10.1093/neuros/nyy178
Colao A, Zgliczy?ski W, Komorowski J, Kos-Kud?a B, Tabarin A, Kerlan V, et al. Efficacy and safety of high-dose long-acting repeatable octreotide as monotherapy or in combination with pegvisomant or cabergoline in patients with acromegaly not adequately controlled by conventional regimens: results of an open-label, multicentre study. Endokrynol Pol. 2019;70(4):305-12. https://doi.org/10.5603/EP.a2019.0023
Muhammad A, Coopmans EC, Delhanty PJ, Dallenga AH, Haitsma IK, Janssen JA, et al. Efficacy and safety of switching to pasireotide in acromegaly patients controlled with pegvisomant and somatostatin analogues: PAPE extension study. Eur J Endocrinol. 2018 nov.;179(5):269-77. https://doi.org/10.1530/EJE-18-0353
Mallea-Gil S, Danilowicz K, Bruera D, Battistone M, Campero A, Chervin AB, et al. Guía de recomendaciones para el diagnóstico clínico, bioquímico y por imágenes de la acromegalia. Federación Argentina de Sociedades de Endocrinología (FASEN) - 2017. Rev Argent Endocrinol Metab. 2018;55(2):100-8.
Leonart LP, Ferreira VL, Tonin FS, Fernandez-Llimos F, Pontarolo R. Medical Treatments for Acromegaly: A Systematic Review and Network Meta-Analysis. Value Health. 2018 jul.;21(7):874-80. https://doi.org/10.1016/j.jval.2017.12.014
Maione L, García C, Bouchachi A, Kallel N, Maison P, Salenave S, et al. No Evidence of a Detrimental Effect of Cabergoline Therapy on Cardiac Valves in Patients with Acromegaly. J Clin Endocrinol Metab. 2012 sept. 1;97(9):E1714-9. https://doi.org/10.1210/jc.2012-1833
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.