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CC BY-NC-ND 4.0 · Journal of Diabetes and Endocrine Practice 2022; 05(03): 092-103
DOI: 10.1055/s-0042-1760392
Review Article

Contemporary Management of Acromegaly: A Practical Approach

Mussa H. Almalki 
1   Obesity, Endocrine and Metabolism Center, King Fahad Medical City, Riyadh, Saudi Arabia
,
Maswood M. Ahmad 
1   Obesity, Endocrine and Metabolism Center, King Fahad Medical City, Riyadh, Saudi Arabia
,
Ali Alqahtani 
1   Obesity, Endocrine and Metabolism Center, King Fahad Medical City, Riyadh, Saudi Arabia
,
Wael M. Almistehi
1   Obesity, Endocrine and Metabolism Center, King Fahad Medical City, Riyadh, Saudi Arabia
,
Aishah Ekhzaimy 
2   Department of Medicine, Endocrinology and Diabetes Unit, College of Medicine and King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
,
Mohammed J. Asha
3   Division of Neurosurgery, Department of Surgery, Tawam Hospital, United Arab Emirates
,
Khaled M. Aldahmani 
4   Department of Medicine, Tawam Hospital, Al Ain, United Arab Emirates
5   Department of Medicine, UAE University, United Arab Emirates
› Institutsangaben Sponsorship and Funding The study received no sponsorship or funding.
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Abstract

Acromegaly is a rare, chronic disease that is, in more than 95% of cases, caused by a growth hormone (GH)-secreting pituitary adenoma. Overproduction of insulin-like growth factor-1 (IGF-1) due to GH hypersecretion leads to various clinical features characterized by somatic overgrowth, physical changes, multiple comorbidities, and increased mortality. The average age at diagnosis is 40 to 50 years, with no sex predilection. The mean delay in diagnosis is 4.5 to 5 years due to the insidious onset and slow clinical progression of the disease. The diagnosis is confirmed by increased levels of IGF-1 and insuppressible GH measured by an oral glucose tolerance test. Treatment is aimed at normalizing GH/IGF-1 levels and controlling tumor volume. Medical treatment and radiotherapy can be utilized when surgery fails to control GH/IGF-1 hypersecretion. This article aims to review recent updates in acromegaly diagnosis and treatment to raise awareness about acromegaly clinical presentation and management.

Keywords

acromegaly - clinical features - diagnosis - mortality - treatment - surgery - medical therapy - radiotherapy - outcome

Authors' Contributions

The authors were assigned specific sections to draft, which were developed into a single manuscript reviewed and approved by all authors.


Compliance with Ethical Principles

Not applicable.




Publikationsverlauf

Artikel online veröffentlicht:
23. Januar 2023

© 2023. Gulf Association of Endocrinology and Diabetes (GAED). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Melmed S. Acromegaly pathogenesis and treatment. J Clin Invest 2009; 119 (11) 3189-3202
    CrossrefPubMedSuche in Google Scholar
  • 2 Giustina A, Barkan A, Beckers A. et al. A consensus on the diagnosis and treatment of acromegaly comorbidities: an update. J Clin Endocrinol Metab 2020; 105 (04) dgz096
    CrossrefPubMedSuche in Google Scholar
  • 3 Gadelha MR, Kasuki L, Lim DST, Fleseriu M. Systemic complications of acromegaly and the impact of the current treatment landscape: an update. Endocr Rev 2019; 40 (01) 268-332
    CrossrefPubMedSuche in Google Scholar
  • 4 Ershadinia N, Tritos NA. Diagnosis and treatment of acromegaly: an update. Mayo Clin Proc 2022; 97 (02) 333-346
    CrossrefPubMedSuche in Google Scholar
  • 5 Melmed S. Medical progress: acromegaly. N Engl J Med 2006; 355 (24) 2558-2573
    CrossrefPubMedSuche in Google Scholar
  • 6 Starnoni D, Daniel RT, Marino L, Pitteloud N, Levivier M, Messerer M. Surgical treatment of acromegaly according to the 2010 remission criteria: systematic review and meta-analysis. Acta Neurochir (Wien) 2016; 158 (11) 2109-2121
    CrossrefPubMedSuche in Google Scholar
  • 7 Bush ZM, Vance ML. Management of acromegaly: is there a role for primary medical therapy?. Rev Endocr Metab Disord 2008; 9 (01) 83-94
    CrossrefPubMedSuche in Google Scholar
  • 8 Lavrentaki A, Paluzzi A, Wass JAH, Karavitaki N. Epidemiology of acromegaly: review of population studies. Pituitary 2017; 20 (01) 4-9
    CrossrefPubMedSuche in Google Scholar
  • 9 Colao A, Grasso LFS, Giustina A. et al. Acromegaly. Nat Rev Dis Primers 2019; 5 (01) 20
    CrossrefPubMedSuche in Google Scholar
  • 10 Gruppetta M, Mercieca C, Vassallo J. Prevalence and incidence of pituitary adenomas: a population based study in Malta. Pituitary 2013; 16 (04) 545-553
    CrossrefPubMedSuche in Google Scholar
  • 11 Agustsson TT, Baldvinsdottir T, Jonasson JG. et al. The epidemiology of pituitary adenomas in Iceland, 1955-2012: a nationwide population-based study. Eur J Endocrinol 2015; 173 (05) 655-664
    CrossrefPubMedSuche in Google Scholar
  • 12 Giustina A, Mancini T, Boscani PF. et al; COM.E.T.A. (COMorbidities Evaluation and Treatment inAcromegaly) Italian Study Group. Assessment of the awareness and management of cardiovascular complications of acromegaly in Italy. The COM.E.T.A. (COMorbidities Evaluation and Treatment in Acromegaly) Study. J Endocrinol Invest 2008; 31 (08) 731-738
    CrossrefPubMedSuche in Google Scholar
  • 13 Giustina A, Barkan A, Casanueva FF. et al. Criteria for cure of acromegaly: a consensus statement. J Clin Endocrinol Metab 2000; 85 (02) 526-529
    PubMedSuche in Google Scholar
  • 14 Ambrosio MR, Gagliardi I, Chiloiro S. et al. Acromegaly in the elderly patients. Endocrine 2020; 68 (01) 16-31
    CrossrefPubMedSuche in Google Scholar
  • 15 Bex M, Abs R, T'Sjoen G. et al. AcroBel–the Belgian registry on acromegaly: a survey of the 'real-life' outcome in 418 acromegalic subjects. Eur J Endocrinol 2007; 157 (04) 399-409
    CrossrefPubMedSuche in Google Scholar
  • 16 Raappana A, Koivukangas J, Ebeling T, Pirilä T. Incidence of pituitary adenomas in Northern Finland in 1992-2007. J Clin Endocrinol Metab 2010; 95 (09) 4268-4275
    CrossrefPubMedSuche in Google Scholar
  • 17 Lenders NF, McCormack AI, Ho KKY. Management of endocrine disease: does gender matter in the management of acromegaly?. Eur J Endocrinol 2020; 182 (05) R67-R82
    CrossrefPubMedSuche in Google Scholar
  • 18 Holdaway IM, Rajasoorya C. Epidemiology of acromegaly. Pituitary 1999; 2 (01) 29-41
    CrossrefPubMedSuche in Google Scholar
  • 19 Ghazi AA, Amirbaigloo A, Dezfooli AA. et al. Ectopic acromegaly due to growth hormone releasing hormone. Endocrine 2013; 43 (02) 293-302
    CrossrefPubMedSuche in Google Scholar
  • 20 Carroll PV, Joshi MN. Acromegaly. 2022 Sep 7. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000–. PMID: 25905322
    PubMedSuche in Google Scholar
  • 21 Clemmons DR. Role of IGF-binding proteins in regulating IGF responses to changes in metabolism. J Mol Endocrinol 2018; 61 (01) T139-T169
    CrossrefPubMedSuche in Google Scholar
  • 22 Landis CA, Masters SB, Spada A, Pace AM, Bourne HR, Vallar L. GTPase inhibiting mutations activate the α chain of Gs and stimulate adenylyl cyclase in human pituitary tumours. Nature 1989; 340 (6236): 692-696
    CrossrefPubMedSuche in Google Scholar
  • 23 Vallar L, Spada A, Giannattasio G. Altered Gs and adenylate cyclase activity in human GH-secreting pituitary adenomas. Nature 1987; 330 (6148): 566-568
    CrossrefPubMedSuche in Google Scholar
  • 24 Akirov A, Asa SL, Amer L, Shimon I, Ezzat S. The Clinicopathological Spectrum of Acromegaly. J Clin Med 2019; 8 (11) 1962
    CrossrefPubMedSuche in Google Scholar
  • 25 Caron P, Brue T, Raverot G. et al. Signs and symptoms of acromegaly at diagnosis: the physician's and the patient's perspectives in the ACRO-POLIS study. Endocrine 2019; 63 (01) 120-129
    CrossrefPubMedSuche in Google Scholar
  • 26 Rajasoorya C, Holdaway IM, Wrightson P, Scott DJ, Ibbertson HK. Determinants of clinical outcome and survival in acromegaly. Clin Endocrinol (Oxf) 1994; 41 (01) 95-102
    CrossrefPubMedSuche in Google Scholar
  • 27 Colao A, Ferone D, Marzullo P, Lombardi G. Systemic complications of acromegaly: epidemiology, pathogenesis, and management. Endocr Rev 2004; 25 (01) 102-152
    CrossrefPubMedSuche in Google Scholar
  • 28 Ahmad MM, Buhary BM, Al Mousawi F. et al. Management of acromegaly: an exploratory survey of physicians from the Middle East and North Africa. Hormones (Athens) 2018; 17 (03) 373-381
    CrossrefPubMedSuche in Google Scholar
  • 29 Fleseriu M, Barkan A, Del Pilar Schneider M. et al. Prevalence of comorbidities and concomitant medication use in acromegaly: analysis of real-world data from the United States. Pituitary 2022; 25 (02) 296-307
    CrossrefPubMedSuche in Google Scholar
  • 30 Molitch ME. Clinical manifestations of acromegaly. Endocrinol Metab Clin North Am 1992; 21 (03) 597-614
    CrossrefPubMedSuche in Google Scholar
  • 31 Drange MR, Fram NR, Herman-Bonert V, Melmed S. Pituitary tumor registry: a novel clinical resource. J Clin Endocrinol Metab 2000; 85 (01) 168-174
    PubMedSuche in Google Scholar
  • 32 Mestron A, Webb SM, Astorga R. et al. Epidemiology, clinical characteristics, outcome, morbidity and mortality in acromegaly based on the Spanish Acromegaly Registry (Registro Espanol de Acromegalia, REA). Eur J Endocrinol 2004; 151 (04) 439-446
    CrossrefPubMedSuche in Google Scholar
  • 33 Jenkins PJ, Sohaib SA, Akker S. et al. The pathology of median neuropathy in acromegaly. Ann Intern Med 2000; 133 (03) 197-201
    CrossrefPubMedSuche in Google Scholar
  • 34 Nagulesparen M, Trickey R, Davies MJ, Jenkins JS. Muscle changes in acromegaly. BMJ 1976; 2 (6041): 914-915
    CrossrefPubMedSuche in Google Scholar
  • 35 Layton MW, Fudman EJ, Barkan A, Braunstein EM, Fox IH. Acromegalic arthropathy. Characteristics and response to therapy. Arthritis Rheum 1988; 31 (08) 1022-1027
    CrossrefPubMedSuche in Google Scholar
  • 36 Lieberman SA, Björkengren AG, Hoffman AR. Rheumatologic and skeletal changes in acromegaly. Endocrinol Metab Clin North Am 1992; 21 (03) 615-631
    CrossrefPubMedSuche in Google Scholar
  • 37 Wassenaar MJE, Biermasz NR, van Duinen N. et al. High prevalence of arthropathy, according to the definitions of radiological and clinical osteoarthritis, in patients with long-term cure of acromegaly: a case-control study. Eur J Endocrinol 2009; 160 (03) 357-365
    CrossrefPubMedSuche in Google Scholar
  • 38 Mazziotti G, Biagioli E, Maffezzoni F. et al. Bone turnover, bone mineral density, and fracture risk in acromegaly: a meta-analysis. J Clin Endocrinol Metab 2015; 100 (02) 384-394
    CrossrefPubMedSuche in Google Scholar
  • 39 McGuffin Jr WL, Sherman BM, Roth F. et al. Acromegaly and cardiovascular disorders. A prospective study. Ann Intern Med 1974; 81 (01) 11-18
    CrossrefPubMedSuche in Google Scholar
  • 40 Fazio S, Cittadini A, Sabatini D. et al. Evidence for biventricular involvement in acromegaly: a Doppler echocardiographic study. Eur Heart J 1993; 14 (01) 26-33
    CrossrefPubMedSuche in Google Scholar
  • 41 Clayton RN. Cardiovascular function in acromegaly. Endocr Rev 2003; 24 (03) 272-277
    CrossrefPubMedSuche in Google Scholar
  • 42 Damjanovic SS, Neskovic AN, Petakov MS. et al. High output heart failure in patients with newly diagnosed acromegaly. Am J Med 2002; 112 (08) 610-616
    CrossrefPubMedSuche in Google Scholar
  • 43 Colao A, Spinelli L, Marzullo P. et al. High prevalence of cardiac valve disease in acromegaly: an observational, analytical, case-control study. J Clin Endocrinol Metab 2003; 88 (07) 3196-3201
    CrossrefPubMedSuche in Google Scholar
  • 44 Coffey S, Cairns BJ, Iung B. The modern epidemiology of heart valve disease. Heart 2016; 102 (01) 75-85
    CrossrefPubMedSuche in Google Scholar
  • 45 Kreze A, Kreze-Spirova E, Mikulecky M. Risk factors for glucose intolerance in active acromegaly. Braz J Med Biol Res 2001; 34 (11) 1429-1433
    CrossrefPubMedSuche in Google Scholar
  • 46 Hoogenberg K, Sluiter WJ, Dullaart RP. Effect of growth hormone and insulin-like growth factor I on urinary albumin excretion: studies in acromegaly and growth hormone deficiency. Acta Endocrinol (Copenh) 1993; 129 (02) 151-157
    PubMedSuche in Google Scholar
  • 47 Weiss V, Sonka K, Pretl M. et al. Prevalence of the sleep apnea syndrome in acromegaly population. J Endocrinol Invest 2000; 23 (08) 515-519
    CrossrefPubMedSuche in Google Scholar
  • 48 Grunstein RR, Ho KY, Sullivan CE. Sleep apnea in acromegaly. Ann Intern Med 1991; 115 (07) 527-532
    CrossrefPubMedSuche in Google Scholar
  • 49 Rolla M, Jawiarczyk-Przybyłowska A, Halupczok-Żyła J. et al. Complications and comorbidities of acromegaly-retrospective study in Polish center. Front Endocrinol (Lausanne) 2021; 12: 642131
    CrossrefPubMedSuche in Google Scholar
  • 50 Broder MS, Neary MP, Chang E, Cherepanov D, Katznelson L. Treatments, complications, and healthcare utilization associated with acromegaly: a study in two large United States databases. Pituitary 2014; 17 (04) 333-341
    CrossrefPubMedSuche in Google Scholar
  • 51 Katznelson L, Kleinberg D, Vance ML. et al. Hypogonadism in patients with acromegaly: data from the multi-centre acromegaly registry pilot study. Clin Endocrinol (Oxf) 2001; 54 (02) 183-188
    CrossrefPubMedSuche in Google Scholar
  • 52 Cheung NW, Boyages SC. The thyroid gland in acromegaly: an ultrasonographic study. Clin Endocrinol (Oxf) 1997; 46 (05) 545-549
    CrossrefPubMedSuche in Google Scholar
  • 53 Gasperi M, Martino E, Manetti L. et al; Acromegaly Study Group of the Italian Society of Endocrinology. Prevalence of thyroid diseases in patients with acromegaly: results of an Italian multi-center study. J Endocrinol Invest 2002; 25 (03) 240-245
    CrossrefPubMedSuche in Google Scholar
  • 54 Renehan AG, Shalet SM. Acromegaly and colorectal cancer: risk assessment should be based on population-based studies. J Clin Endocrinol Metab 2002; 87 (04) 1909 , author reply 1909
    PubMedSuche in Google Scholar
  • 55 Rokkas T, Pistiolas D, Sechopoulos P, Margantinis G, Koukoulis G. Risk of colorectal neoplasm in patients with acromegaly: a meta-analysis. World J Gastroenterol 2008; 14 (22) 3484-3489
    CrossrefPubMedSuche in Google Scholar
  • 56 Jenkins PJ, Frajese V, Jones AM. et al. Insulin-like growth factor I and the development of colorectal neoplasia in acromegaly. J Clin Endocrinol Metab 2000; 85 (09) 3218-3221
    PubMedSuche in Google Scholar
  • 57 Wolinski K, Czarnywojtek A, Ruchala M. Risk of thyroid nodular disease and thyroid cancer in patients with acromegaly–meta-analysis and systematic review. PLoS One 2014; 9 (02) e88787
    CrossrefPubMedSuche in Google Scholar
  • 58 Wright AD, Hill DM, Lowy C, Fraser TR. Mortality in acromegaly. Q J Med 1970; 39 (153) 1-16
    Suche in Google Scholar
  • 59 Bolfi F, Neves AF, Boguszewski CL, Nunes-Nogueira VS. Mortality in acromegaly decreased in the last decade: a systematic review and meta-analysis. Eur J Endocrinol 2018; 179 (01) 59-71
    CrossrefPubMedSuche in Google Scholar
  • 60 Ritvonen E, Löyttyniemi E, Jaatinen P. et al. Mortality in acromegaly: a 20-year follow-up study. Endocr Relat Cancer 2016; 23 (06) 469-480
    CrossrefPubMedSuche in Google Scholar
  • 61 Esposito D, Ragnarsson O, Granfeldt D, Marlow T, Johannsson G, Olsson DS. Decreasing mortality and changes in treatment patterns in patients with acromegaly from a nationwide study. Eur J Endocrinol 2018; 178 (05) 459-469
    CrossrefPubMedSuche in Google Scholar
  • 62 Wu J-C, Huang W-C, Chang H-K, Ko C-C, Lirng JF, Chen Y-C. Natural history of acromegaly: incidences, re-operations, cancers, and mortality rates in a national cohort. Neuroendocrinology 2020; 110 (11-12): 977-987
    CrossrefPubMedSuche in Google Scholar
  • 63 Arosio M, Reimondo G, Malchiodi E. et al; Italian Study Group of Acromegaly. Predictors of morbidity and mortality in acromegaly: an Italian survey. Eur J Endocrinol 2012; 167 (02) 189-198
    CrossrefPubMedSuche in Google Scholar
  • 64 Holdaway IM, Rajasoorya RC, Gamble GD. Factors influencing mortality in acromegaly. J Clin Endocrinol Metab 2004; 89 (02) 667-674
    CrossrefPubMedSuche in Google Scholar
  • 65 Colao A, Vandeva S, Pivonello R. et al. Could different treatment approaches in acromegaly influence life expectancy? A comparative study between Bulgaria and Campania (Italy). Eur J Endocrinol 2014; 171 (02) 263-273
    CrossrefPubMedSuche in Google Scholar
  • 66 Bogazzi F, Colao A, Rossi G. et al. Comparison of the effects of primary somatostatin analogue therapy and pituitary adenomectomy on survival in patients with acromegaly: a retrospective cohort study. Eur J Endocrinol 2013; 169 (03) 367-376
    CrossrefPubMedSuche in Google Scholar
  • 67 McCabe J, Ayuk J, Sherlock M. Treatment factors that influence mortality in acromegaly. Neuroendocrinology 2016; 103 (01) 66-74
    CrossrefPubMedSuche in Google Scholar
  • 68 Esposito D, Ragnarsson O, Johannsson G, Olsson DS. Prolonged diagnostic delay in acromegaly is associated with increased morbidity and mortality. Eur J Endocrinol 2020; 182 (06) 523-531
    CrossrefPubMedSuche in Google Scholar
  • 69 Sherlock M, Ayuk J, Tomlinson JW. et al. Mortality in patients with pituitary disease. Endocr Rev 2010; 31 (03) 301-342
    CrossrefPubMedSuche in Google Scholar
  • 70 Schneider HJ, Kosilek RP, Günther M. et al. A novel approach to the detection of acromegaly: accuracy of diagnosis by automatic face classification. J Clin Endocrinol Metab 2011; 96 (07) 2074-2080
    CrossrefPubMedSuche in Google Scholar
  • 71 Kong X, Gong S, Su L, Howard N, Kong Y. Automatic detection of acromegaly from facial photographs using machine learning methods. EBioMedicine 2018; 27: 94-102
    CrossrefPubMedSuche in Google Scholar
  • 72 Katznelson L, Laws Jr ER, Melmed S. et al; Endocrine Society. Acromegaly: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 2014; 99 (11) 3933-3951
    CrossrefPubMedSuche in Google Scholar
  • 73 Freda PU. Pitfalls in the biochemical assessment of acromegaly. Pituitary 2003; 6 (03) 135-140
    CrossrefPubMedSuche in Google Scholar
  • 74 Duncan E, Wass JA. Investigation protocol: acromegaly and its investigation. Clin Endocrinol (Oxf) 1999; 50 (03) 285-293
    CrossrefPubMedSuche in Google Scholar
  • 75 Bonert V, Carmichael J, Wu Z. et al. Discordance between mass spectrometry and immunometric IGF-1 assay in pituitary disease: a prospective study. Pituitary 2018; 21 (01) 65-75
    CrossrefPubMedSuche in Google Scholar
  • 76 Giustina A, Barkhoudarian G, Beckers A. et al. Multidisciplinary management of acromegaly: a consensus. Rev Endocr Metab Disord 2020; 21 (04) 667-678
    CrossrefPubMedSuche in Google Scholar
  • 77 Dobri G, Niwattisaiwong S, Bena JF. et al. Is GH nadir during OGTT a reliable test for diagnosis of acromegaly in patients with abnormal glucose metabolism?. Endocrine 2019; 64 (01) 139-146
    CrossrefPubMedSuche in Google Scholar
  • 78 Lonser RR, Kindzelski BA, Mehta GU, Jane Jr JA, Oldfield EH. Acromegaly without imaging evidence of pituitary adenoma. J Clin Endocrinol Metab 2010; 95 (09) 4192-4196
    CrossrefPubMedSuche in Google Scholar
  • 79 Melmed S, Bronstein MD, Chanson P. et al. A Consensus Statement on acromegaly therapeutic outcomes. Nat Rev Endocrinol 2018; 14 (09) 552-561
    CrossrefPubMedSuche in Google Scholar
  • 80 Fleseriu M, Langlois F, Lim DST, Varlamov EV, Melmed S. Acromegaly: pathogenesis, diagnosis, and management. Lancet Diabetes Endocrinol 2022; 10 (11) 804-826
    CrossrefPubMedSuche in Google Scholar
  • 81 Giustina A, Chanson P, Bronstein MD. et al; Acromegaly Consensus Group. A consensus on criteria for cure of acromegaly. J Clin Endocrinol Metab 2010; 95 (07) 3141-3148
    CrossrefPubMedSuche in Google Scholar
  • 82 Hazer DB, Işık S, Berker D. et al. Treatment of acromegaly by endoscopic transsphenoidal surgery: surgical experience in 214 cases and cure rates according to current consensus criteria. J Neurosurg 2013; 119 (06) 1467-1477
    CrossrefPubMedSuche in Google Scholar
  • 83 Asha MJ, Takami H, Velasquez C. et al. Long-term outcomes of transsphenoidal surgery for management of growth hormone-secreting adenomas: single-center results. J Neurosurg 2019; 133 (05) 1-11
    Suche in Google Scholar
  • 84 Briceno V, Zaidi HA, Doucette JA. et al. Efficacy of transsphenoidal surgery in achieving biochemical cure of growth hormone-secreting pituitary adenomas among patients with cavernous sinus invasion: a systematic review and meta-analysis. Neurol Res 2017; 39 (05) 387-398
    CrossrefPubMedSuche in Google Scholar
  • 85 Cardinal T, Rutkowski MJ, Micko A. et al. Impact of tumor characteristics and pre- and postoperative hormone levels on hormonal remission following endoscopic transsphenoidal surgery in patients with acromegaly. Neurosurg Focus 2020; 48 (06) E10
    CrossrefPubMedSuche in Google Scholar
  • 86 Gadelha MR, Wildemberg LE, Kasuki L. The future of somatostatin receptor ligands in acromegaly. J Clin Endocrinol Metab 2022; 107 (02) 297-308
    CrossrefPubMedSuche in Google Scholar
  • 87 Fleseriu M, Dreval A, Bondar I. et al. Maintenance of response to oral octreotide compared with injectable somatostatin receptor ligands in patients with acromegaly: a phase 3, multicentre, randomised controlled trial. Lancet Diabetes Endocrinol 2022; 10 (02) 102-111
    CrossrefPubMedSuche in Google Scholar
  • 88 Bernabéu I, Fajardo C, Marazuela M. et al. Effectiveness of lanreotide autogel 120 mg at extended dosing intervals for acromegaly. Endocrine 2020; 70 (03) 575-583
    CrossrefPubMedSuche in Google Scholar
  • 89 Bolanowski M, Kałużny M, Witek P, Jawiarczyk-Przybyłowska A. Pasireotide-a novel somatostatin receptor ligand after 20 years of use. Rev Endocr Metab Disord 2022; 23 (03) 601-620
    CrossrefPubMedSuche in Google Scholar
  • 90 Gadelha MR, Bronstein MD, Brue T. et al; Pasireotide C2402 Study Group. Pasireotide versus continued treatment with octreotide or lanreotide in patients with inadequately controlled acromegaly (PAOLA): a randomised, phase 3 trial. Lancet Diabetes Endocrinol 2014; 2 (11) 875-884
    CrossrefPubMedSuche in Google Scholar
  • 91 Almalki MH, Aljohani N, Alzahrani S. et al. Clinical features, therapeutic trends, and outcome of giant prolactinomas: a single-center experience over a 12-year period. Clin Med Insights Endocrinol Diabetes 2020; 13: 1179551420926181
    CrossrefPubMedSuche in Google Scholar
  • 92 Sandret L, Maison P, Chanson P. Place of cabergoline in acromegaly: a meta-analysis. J Clin Endocrinol Metab 2011; 96 (05) 1327-1335
    CrossrefPubMedSuche in Google Scholar
  • 93 Sahin S, Fidan MC, Korkmaz OP, Durcan E, Ozkaya HM, Kadioglu P. Effectiveness of cabergoline treatment in patients with acromegaly uncontrolled with SSAs: experience of a single tertiary center. Exp Clin Endocrinol Diabetes 2021; 129 (09) 644-650
    Thieme ConnectPubMedSuche in Google Scholar
  • 94 van der Lely AJ, Hutson RK, Trainer PJ. et al. Long-term treatment of acromegaly with pegvisomant, a growth hormone receptor antagonist. Lancet 2001; 358 (9295): 1754-1759
    CrossrefPubMedSuche in Google Scholar
  • 95 Leonart LP, Tonin FS, Ferreira VL, Fernandez-Llimos F, Pontarolo R. Effectiveness and safety of pegvisomant: a systematic review and meta-analysis of observational longitudinal studies. Endocrine 2019; 63 (01) 18-26
    CrossrefPubMedSuche in Google Scholar
  • 96 Fleseriu M, Führer-Sakel D, van der Lely AJ. et al. More than a decade of real-world experience of pegvisomant for acromegaly: ACROSTUDY. Eur J Endocrinol 2021; 185 (04) 525-538
    CrossrefPubMedSuche in Google Scholar
  • 97 Chiloiro S, Costa D, Lauretta R. et al. Partial response to first generation SSA guides the choice and predict the outcome of second line therapy in acromegaly. Endocrine 2022; 78 (02) 343-353
    CrossrefPubMedSuche in Google Scholar
  • 98 Ishida A, Shichi H, Fukuoka H, Shiramizu H, Inoshita N, Yamada S. Temozolomide and capecitabine treatment for an aggressive somatotroph pituitary tumor: a case report and literature review. Front Oncol 2022; 12: 916982
    CrossrefPubMedSuche in Google Scholar
  • 99 Giustina A, Barkan A, Chanson P. et al; Pituitary Society, ; European Neuroendocrine Association. Guidelines for the treatment of growth hormone excess and growth hormone deficiency in adults. J Endocrinol Invest 2008; 31 (09) 820-838
    CrossrefPubMedSuche in Google Scholar
  • 100 Melmed S, Colao A, Barkan A. et al; Acromegaly Consensus Group. Guidelines for acromegaly management: an update. J Clin Endocrinol Metab 2009; 94 (05) 1509-1517
    CrossrefPubMedSuche in Google Scholar
  • 101 Hannon MJ, Barkan AL, Drake WM. The role of radiotherapy in acromegaly. Neuroendocrinology 2016; 103 (01) 42-49
    CrossrefPubMedSuche in Google Scholar
  • 102 Eastman RC, Gorden P, Glatstein E, Roth J. Radiation therapy of acromegaly. Endocrinol Metab Clin North Am 1992; 21 (03) 693-712
    CrossrefPubMedSuche in Google Scholar
  • 103 Powell JS, Wardlaw SL, Post KD, Freda PU. Outcome of radiotherapy for acromegaly using normalization of insulin-like growth factor I to define cure. J Clin Endocrinol Metab 2000; 85 (05) 2068-2071
    PubMedSuche in Google Scholar
  • 104 Biermasz NR, van Dulken H, Roelfsema F. Long-term follow-up results of postoperative radiotherapy in 36 patients with acromegaly. J Clin Endocrinol Metab 2000; 85 (07) 2476-2482
    CrossrefPubMedSuche in Google Scholar
  • 105 Gheorghiu ML. Updates in outcomes of stereotactic radiation therapy in acromegaly. Pituitary 2017; 20 (01) 154-168
    CrossrefPubMedSuche in Google Scholar
  • 106 Fleseriu M, Biller BMK, Freda PU. et al. A Pituitary Society update to acromegaly management guidelines. Pituitary 2021; 24 (01) 1-13
    CrossrefPubMedSuche in Google Scholar
  • 107 Abu Dabrh AM, Asi N, Farah WH. et al. Radiotherapy versus radiosurgery in treating patients with acromegaly: a systematic review and meta-analysis. Endocr Pract 2015; 21 (08) 943-956
    CrossrefPubMedSuche in Google Scholar
  • 108 Erfurth EM, Bülow B, Mikoczy Z, Svahn-Tapper G, Hagmar L. Is there an increase in second brain tumours after surgery and irradiation for a pituitary tumour?. Clin Endocrinol (Oxf) 2001; 55 (05) 613-616
    CrossrefPubMedSuche in Google Scholar
  • 109 Minniti G, Traish D, Ashley S, Gonsalves A, Brada M. Risk of second brain tumor after conservative surgery and radiotherapy for pituitary adenoma: update after an additional 10 years. J Clin Endocrinol Metab 2005; 90 (02) 800-804
    CrossrefPubMedSuche in Google Scholar