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      The Cost of Medical Care for the Acromegalic Patient

      a , b

      Neuroendocrinology

      S. Karger AG

      Acromegaly, Health care costs, Pituitary adenomas

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          Abstract

          Despite ample proof to the contrary, the overwhelming number of health care practitioners still believe that acromegaly is a disease that they will rarely encounter, let alone have to treat. However, the reality is quite a bit different for both doctors and patients. Many of the obvious symptoms and signs of this disease manifest slowly and insidiously. As such, the majority of patients are often treated for seemingly unrelated conditions for years before the actual diagnosis of acromegaly is established. Thus, the overall cost of medical care for the acromegalic patient is considerably higher than appreciated at first glance. The financial cost of managing this disease must include the cost of care of comorbid conditions before and following the diagnosis of acromegaly. It is only through a higher degree of awareness that this disease will be identified earlier in its course and the true number of acromegalic patients is realized. We anticipate that such measures will serve to limit the psychological, emotional and economic burden of this potentially debilitating disease.

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          Most cited references 3

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          The prevalence of pituitary adenomas: a systematic review.

          Pituitary adenomas display an array of hormonal and proliferative activity. Once primarily classified according to size (microadenomas, or = 1 cm), these tumors are now further classified according to immunohistochemistry and functional status. With these additional classifications in mind, the goals of the current study were to determine the prevalence of pituitary adenomas and to explore the clinical relevance of the findings. The authors conducted a metaanalysis of all existing English-language articles in MEDLINE. They used the search string (pituitary adenoma or pituitary tumor) and prevalence and selected relevant autopsy and imaging evaluation studies for inclusion. The authors found an overall estimated prevalence of pituitary adenomas of 16.7% (14.4% in autopsy studies and 22.5% in radiologic studies). Given the high frequency of pituitary adenomas and their potential for causing clinical pathologies, the findings of the current study suggest that early diagnosis and treatment of pituitary adenomas should have far-reaching benefits.
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            Perioperative management of patients undergoing transsphenoidal pituitary surgery.

            Pituitary adenomas often present with the symptoms of hormonal hypersecretion, and although medical therapy is available for most hyperfunctioning states, it is not curative. As a result, transsphenoidal pituitary surgery has become a commonly performed neurosurgical procedure with unique challenges for the anesthesiologist due to the distinct medical comorbidities associated with various adenomas. Any type of pituitary tumor may also produce hypopituitarism and local mass effects secondary to the expanding intrasellar mass. Here we review the perioperative concerns surrounding surgery to remove adenomas and decompress the sellar space. Special attention is given to Cushing's disease (hypercortisolism secondary to an adrenocorticotropic hormone-secreting adenoma), acromegaly (secondary to a growth hormone-secreting adenoma), and hyperthyroidism in the setting of thyrotropic adenomas. Operative risks, including bleeding, diabetes insipidus, the syndrome of inappropriate antidiuretic hormone secretion, and hypopituitarism, are addressed in detail. Understanding preoperative assessment, intraoperative management, potential complications, their management, and strategies for avoidance are fundamental to successful perioperative patient care and avoidance of morbidity and mortality.
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              The 'bio-assay' quality of life might be a better marker of disease activity in acromegalic patients than serum total IGF-I concentrations.

              To investigate the quality of life (QoL) in acromegalic patients in relation to biochemical parameters. Single-center, open label study in 14 acromegalic patients (eight woman and six men, age 33-77 years), with normal serum IGF-I levels during long-term treatment with monthly injections of 20 mg of long-acting octreotide. We investigated which biochemical parameter might reflect optimal QoL, using the SF-36 questionnaire. We observed that six patients had a low QoL score at baseline in the same range as observed in cancer patients. The other eight patients had a normal QoL. GH, IGF-I nor free IGF-I could discriminate these two subgroups at baseline. After skipping one monthly injection, all six subjects with the low QoL escaped in their free IGF-I concentrations. Also total IGF-I concentrations escaped in four of these six. In the subjects with normal QoL, free IGF-I levels remained normal in all, while total IGF-I levels only escaped in one. This study tells us that the currently used biochemical criteria for disease control in acromegaly might be sufficient in assessing long-term mortality and morbidity, but they are insufficient in addressing the most important parameter from the patient's perspective--QoL.
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                Author and article information

                Journal
                NEN
                Neuroendocrinology
                10.1159/issn.0028-3835
                Neuroendocrinology
                S. Karger AG
                978-3-8055-8198-1
                978-3-318-01414-3
                0028-3835
                1423-0194
                2006
                October 2006
                16 October 2006
                : 83
                : 3-4
                : 139-144
                Affiliations
                aPituitary Network Association, Thousand Oaks, Calif., USA; bUniversity of Toronto, Toronto, Canada
                Article
                95521 Neuroendocrinology 2006;83:139–144
                10.1159/000095521
                17047376
                © 2006 S. Karger AG, Basel

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

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                Figures: 2, References: 5, Pages: 6
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