Acromegaly management in the Nordic countries: A Delphi consensus survey.
Clin Endocrinol (Oxf)
; 101(3): 263-273, 2024 Sep.
Article
in En
| MEDLINE
| ID: mdl-38865284
ABSTRACT
OBJECTIVE:
Acromegaly is associated with increased morbidity and mortality if left untreated. The therapeutic options include surgery, medical treatment, and radiotherapy. Several guidelines and recommendations on treatment algorithms and follow-up exist. However, not all recommendations are strictly evidence-based. To evaluate consensus on the treatment and follow-up of patients with acromegaly in the Nordic countries.METHODS:
A Delphi process was used to map the landscape of acromegaly management in Denmark, Sweden, Norway, Finland, and Iceland. An expert panel developed 37 statements on the treatment and follow-up of patients with acromegaly. Dedicated endocrinologists (n = 47) from the Nordic countries were invited to rate their extent of agreement with the statements, using a Likert-type scale (1-7). Consensus was defined as ≥80% of panelists rating their agreement as ≥5 or ≤3 on the Likert-type scale.RESULTS:
Consensus was reached in 41% (15/37) of the statements. Panelists agreed that pituitary surgery remains first line treatment. There was general agreement to recommend first-generation somatostatin analog (SSA) treatment after failed surgery and to consider repeat surgery. In addition, there was agreement to recommend combination therapy with first-generation SSA and pegvisomant as second- or third-line treatment. In more than 50% of the statements, consensus was not achieved. Considerable disagreement existed regarding pegvisomant monotherapy, and treatment with pasireotide and dopamine agonists.CONCLUSION:
This consensus exploration study on the management of patients with acromegaly in the Nordic countries revealed a relatively large degree of disagreement among experts, which mirrors the complexity of the disease and the shortage of evidence-based data.Key words
Full text:
1
Database:
MEDLINE
Main subject:
Acromegaly
/
Somatostatin
/
Delphi Technique
Limits:
Humans
Country/Region as subject:
Europa
Language:
En
Journal:
Clin Endocrinol (Oxf)
/
Clin. endocrinol
/
Clinical endocrinology
Year:
2024
Type:
Article
Affiliation country:
Denmark