Medical Guidelines for Clinical Practice for the Diagnosis and Treatment of Acromegaly
Though these guidelines have not been updated in six years, they are the American Association of Clinical Endocrinology’s standard resource for physicians looking for guidance on how best to manage the patient with acromegaly. Among other topics, the guidelines cover the roles of surgical treatment, medical treatment, and radiation therapy in acromegaly management.
Guidelines for Acromegaly Management: An Update
If you’re looking for more recent guidelines than the AACE provides, follow this link and peruse the recommendations of the Acromegaly Consensus Group from their November 2007 meeting, sponsored by the Pituitary Society and the European Neuroendocrine Association.
Management of Pituitary Adenomas
This expired CME webcast comprises three presentations made “at the live CMES ancillary symposium entitled ‘Management of Pituitary Adenomas,’ held in conjunction with The Endocrine Society's 90th Annual Meeting on June 16, 2008 in San Francisco, CA”: Treatment Options for Acromegaly, Uncertainties in the Treatment of Prolactinomas, and Pharmacologic Therapy for Cushing’s: The Old and the New. Though you will not obtain credit for viewing any of this, the activity can still serve as a relevant refresher.
Sponsored by the Department of Radiology and Radiological Sciences at the Uniformed Services University of the Health Science, this small image library contains 13 acromegaly-related magnetic resonance and x-ray scans illustrating dramatic skull thickening, pituitary macroadenoma, and acromegaly vs. gigantism.
//The Educated PatientTM
Diagnosis and Treatment of Acromegaly
This resource from the Stanford Cancer Center is about as basic a patient primer as it gets. It provides an overview of the disease, explains how it is diagnosed, and therapeutic options available to patients (including information on receiving treatment at Stanford). You can turn this into a two-page patient handout with some quick text size adjustments.
Tanya Angus “is the only known person in the world [whose acromegaly] can not be treated successfully with surgery or drugs.” This heart-breaking reality was reinforced recently when a hoped-for procedure to remove her pituitary tumor was cancelled because the surgeon ultimately deemed it too risky. For recently diagnosed patients, reading her words and about her life will hopefully inspire and comfort.
Living with Gigantism
This ABC News story on Tanya Angus will help patients get a better idea of what life with acromegaly can potentially be like.
Pure Endoscopic Transsphenoidal Surgery for Treatment of Acromegaly
Journal:Journal of Neurosurgery (October 2010)
Authors: Gondim J, Almeida J, de Albuquerque L, et al
Purpose: “The authors discuss the advantages, outcome, complications, and factors related to the success of the endoscopic approach in cases of GHsecreting adenomas” in a population “of patients with acromegaly who were operated on by a pituitary specialist surgeon.”
Results: The procedure had a high rate of success (“disease control was obtained in” 74.6% of cases; “the rate of treatment success was higher in patients with microadenomas…12 of 14 cases”) and a low incidence of complications (“epistaxis (6.0%), transitory diabetes insipidus (4.5%), and 1 case of seizure (1.5%)”). “Lesion size, suprasellar/parasellar extension, and the degree of sella floor erosion” are important factors related to success. The authors indicate that this procedure is an effective treatment option, however, they found that “there is no conclusive evidence that endoscopy is superior to microsurgery in treatment of GH-secreting adenomas.”
Biochemical Acromegaly in Patients with Prolactinoma during Treatment with Dopaminergic Agonists
Journal: Arquivos Brasileiros de Endocrinologia & Metabologia (August 2010)
Authors: Rosário P, Purisch S
Purpose: The authors studied “one hundred twenty one patients without a phenotype suggestive of acromegaly” in order to “evaluate the frequency of sublinical acromegaly (in the absence of clinical phenotype but biochemically uncontrolled).”
Results: “Initially, the laboratory diagnosis of acromegaly was unequivocal” and a repetition of testing “6 months after withdrawal of the dopaminergic agonist confirmed the diagnosis of sublinical acromegaly.” The authors recommend that “n patients with prolactinomas, acromegaly should be investigated not only in cases with a clinical phenotype.”
Approach to the Patient with Persistent Acromegaly after Pituitary Surgery
Credits: Not Listed
Expiration Date: October 19, 2013
“In the acromegaly patient with persistent disease after surgery, therapeutic options including medical therapies allow disease control in the majority of patients.” This activity discusses those options which include “medical therapy, utilizing somatostatin analogs, dopamine agonists, and pegvisomant;” and radiation therapy. Situations in which repeat surgery is called for are also covered.
The Journal of Neurosurgery Podcast Archive: Acromegaly
Dr. Edward Laws of Brigham and Women’s Hospital interviews Dr. M. Beatriz Lopes of the University of Virginia School of Medicine about “Growth Hormone-secreting Ademonas: Pathology and Cell Biology,” and article authored by Dr. Lopes which was published in the October 2010 issue of the Journal of Neurosurgery (http://hcp.lv/cRCNZt). In the article, Dr. Lopes “reviews the main pathological features of the GH-secreting adenomas and some of the molecular genetics mechanisms involved in their pathogenesis.”
January 15-19, 2011
Clinical Diabetes & Endocrinology
Snowmass Conference Center
Snowmass Village, Colorado
Somatuline Depot (lanreotide)
Preoperative Lanreotide Treatment in Acromegalic Patients with Macroadenomas Increases Short-term Postoperative Cure Rates
Journal: European Journal of Endocrinology (April 2010)
Authors: Zhi-gang M, Yong-hong Z, Hai-liang T, et al
Purpose: Researchers tested the hypothesis that a “4-month preoperative lanreotide treatmentwould improve the surgical cure rate of newly diagnosed acromegalicpatients with macroadenomas.”
Results: Researchers randomly divided 108 patients into two groups, the first receiving a four month preoperative regimen of lanreotide, the other moving directly to transsphenoidal surger. Cure, defined as “fasting IGF1 less than or equal to age-adjusted upper limit of normal,” was “established in 24 of 49 pretreated patients versus 9 of 49 direct surgery patients. Surgical morbidity was similar in both groups.
Somatuline Depot for Acromegaly Post-Marketing Observational Study
Study Type: Observational
Age/Gender Requirements:18 years (male/female)
Sponsor:Cedars-Sinai Medical Center
Purpose:Researchers will draw blood from study participants in order to assess blood levels, which are currently unknown “in patients getting this drug,” because “it may be critical to know the levels in patients whose symptoms are poorly controlled.”