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      Updates in Diagnosis and Treatment of Acromegaly

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          Abstract

          Acromegaly is a rare disease, caused largely by a growth hormone (GH) pituitary adenoma. Incidence is higher than previously thought. Due to increased morbidity and mortality, if not appropriately treated, early diagnosis efforts are essential. Screening is recommended for all patients with clinical features of GH excess. There is increased knowledge that classical diagnostic criteria no longer apply to all, and some patients can have GH excess with normal GH response to glucose. Treatment is multifactorial and personalised therapy is advised.

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          Acromegaly: an endocrine society clinical practice guideline.

          Laurence Katznelson, Edward Laws, Shlomo Melmed … (2014)
          The aim was to formulate clinical practice guidelines for acromegaly.
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            Prevalence of pituitary adenomas: a community-based, cross-sectional study in Banbury (Oxfordshire, UK).

            Alberto Fernandez, Niki Karavitaki, John Wass (2010)
            Pituitary adenomas (PAs) are associated with increased morbidity and mortality. The optimal delivery of services and the provision of care for patients with PAs require distribution of the resources proportionate to the impact of these conditions on the community. Currently, the resource allocation for PAs in the health care system is lacking a reliable and an up-to-date epidemiological background that would reflect the recent advances in the diagnostic technologies, leading to the earlier recognition of these tumours. To determine the prevalence, the diagnostic delay and the characteristics of patients with PA in a well-defined geographical area of the UK (Banbury, Oxfordshire). Sixteen general practitioner (GP) surgeries covering the area of Banbury and a total population of 89 334 inhabitants were asked to participate in the study (data confirmed on 31 July 2006). Fourteen surgeries with a total of 81,449 inhabitants (91% of the study population) agreed to take part. All cases of PAs were found following an exhaustive computer database search of agreed terms by the staff of each Practice and data on age, gender, presenting manifestations and their duration, imaging features at diagnosis, history of multiple endocrine neoplasia type 1 and family history of PA were collected. A total of 63 patients with PA were identified amongst the study population of 81,149, with a prevalence of 77.6 PA cases/100,000 inhabitants (prolactinomas; PRLoma: 44.4, nonfunctioning PAs: 22.2, acromegaly; ACRO: 8.6, corticotroph adenoma: 1.2 and unknown functional status; UFS: 1.2/100,000 inhabitants). The distribution of each PA subtype was for PRLoma 57%, nonfunctioning PAs 28%, ACRO 11%, corticotroph adenoma 2% and UFS 2%. The median age at diagnosis and the duration of symptoms until diagnosis (in years) were for PRLoma 32.0 and 1.5, nonfunctioning PAs 51.5 and 0.8, ACRO 47 and 4.5 and corticotroph adenoma 57 and 7, respectively. PRLoma was the most frequent PA diagnosed up to the age of 60 years (0-20 years: 75% and 20-60 years: 61% of PAs) and nonfunctioning PA after the age of 60 years (60% of PAs). Nonfunctioning PAs dominated in men (57% of all men with PA) and PRLoma in women (76% of all women with PA). Five patients (7.9%) presented with classical pituitary apoplexy, with a prevalence of 6.2 cases/100,000 inhabitants. Based on a well-defined population in Banbury (Oxfordshire, UK), we have shown that PAs have a fourfold increased prevalence than previously thought; our data confirm that PAs have a higher burden on the Health Care System and optimal resource distribution for both clinical care and research activities aiming to improve the outcome of these patients are needed.
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              High prevalence of pituitary adenomas: a cross-sectional study in the province of Liege, Belgium.

              Adrian F. Daly, Martine Rixhon, Christelle Adam … (2006)
              Prevalence data are important for assessing the burden of disease on the health care system; data on pituitary adenoma prevalence are very scarce. The objective of the study was to measure the prevalence of clinically relevant pituitary adenomas in a well-defined population. This was a cross-sectional, intensive, case-finding study performed in three regions of the province of Liège, Belgium, to measure pituitary adenoma prevalence as of September 30, 2005. The study was conducted in specialist and general medical practitioner patient populations, referral hospitals, and investigational centers. Three demographically and geographically distinct districts of the province of Liège were delineated precisely using postal codes. Medical practitioners in these districts were recruited, and patients with pituitary adenomas under their care were identified. Diagnoses were confirmed after retrieval of clinical, hormonal, radiological, and pathological data; full demographic and therapeutic follow-up data were collected in all cases. Sixty-eight patients with clinically relevant pituitary adenomas were identified in a population of 71,972 individuals; the mean (+/- sd) prevalence was 94 +/- 19.3 cases per 100,000 population (95% confidence interval, 72.2 to 115.8). The group was 67.6% female and had a mean age at diagnosis of 40.3 yr; 42.6% had macroadenomas and 55.9% underwent surgery. Prolactinomas comprised 66% of the group, with the rest having nonsecreting tumors (14.7%), somatotropinomas (13.2%), or Cushing's disease (5.9%); 20.6% had hypopituitarism. The prevalence of pituitary adenomas in the study population (one case in 1064 individuals) was more than 3.5-5 times that previously reported. This increased prevalence may have important implications when prioritizing funding for research and treatment of pituitary adenomas.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Eur Endocrinol
                Journal ID (iso-abbrev): Eur Endocrinol
                Journal ID (publisher-id): EE
                Title: European Endocrinology
                Publisher: Touch Medical Media
                ISSN (Print): 1758-3772
                ISSN (Electronic): 1758-3780
                Publication date (Print): September 2018
                Publication date (Electronic): 10 September 2018
                Volume: 14
                Issue: 2
                Pages: 57-61
                Affiliations
                [1 ] Department of Medicine, Division of Endocrinology, Diabetes and Clinical Nutrition
                [2 ] Department of Neurological Surgery
                [3 ] Northwest Pituitary Center, Oregon Health & Science University, Portland, OR, US
                Author notes
                Corresponding Author: Maria Fleseriu, Northwest Pituitary Center, Department of Neurological Surgery, Oregon Health & Science University, Mail Code CH8N, 3303 SW Bond Ave Portland, OR 97239, US. E: fleseriu@ 123456ohsu.edu

                Disclosure: Maria Fleseriu has been a principal investigator with research support to Oregon Health & Science University for clinical research studies with Novartis, Chiasma and Pfizer, and she has been an occasional scientific consultant for Novartis, Pfizer, Ipsen, Ionis and Chiasma. Roula Zahr has no conflict of interest.

                Article
                DOI: 10.17925/EE.2018.14.2.57
                PMC ID: 6182922
                PubMed ID: 30349595
                SO-VID: 99aa9d60-cc6f-47c9-b07e-b76b1da268cc
                Copyright statement: © The Author(s) 2018
                License:

                This article is published under the Creative Commons Attribution Noncommercial License, which permits any non-commercial use, distribution, adaptation and reproduction provided the original author(s) and source are given appropriate credit. © The Authors 2018.

                Review Process: Double-blind peer review

                Authorship: All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship of this manuscript, take responsibility for the integrity of the work as a whole, and have given final approval to the version to be published.

                History
                Date received : 16 February 2018
                Date accepted : 3 May 2018
                Page count
                Pages: 5
                Funding
                Support: No funding was received in the publication of this article.
                Categories
                Subject: Pituitary

                Keywords: acromegaly,growth hormone,pituitary adenoma,somatostatin receptor ligand
                Data availability:
                Keywords: acromegaly, growth hormone, pituitary adenoma, somatostatin receptor ligand

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