Diagnosis, treatment and follow-up of patients with acromegaly in a clinical practice setting in Spain: the ACROPRAXIS program Delphi survey

• Published in: Pituitary Vol. 23; no. 2; pp. 129 - 139
• Main Authors: de Pablos-Velasco, Pedro, Venegas, Eva María, Álvarez Escolá, Cristina, Fajardo, Carmen, de Miguel, Paz, González, Natividad, Bernabéu, Ignacio, Valdés, Nuria, Paja, Miguel, Díez, Juan José, Biagetti, Betina
• Format: Journal Article
• Language: English
• Published: New York Springer US 01-04-2020; Springer Nature B.V
• Subjects: Acromegaly; Acromegaly - diagnosis; Acromegaly - drug therapy; Acromegaly - epidemiology; Acromegaly - surgery; Adolescent; Adult; Anesthesia; Child; Compression; Diagnosis; Endocrinologists; Endocrinology; Female; Glucose tolerance; Glucose Tolerance Test; Growth hormone; Growth Hormone - blood; Human Physiology; Humans; Insulin; Insulin-like growth factor I; Insulin-Like Growth Factor I - metabolism; Male; Medicine; Medicine & Public Health; Middle Aged; Patients; Pituitary; Remission; Somatostatin; Somatostatin - analogs & derivatives; Somatostatin - therapeutic use; Spain - epidemiology; Surgery; Young Adult; Spain; Acromegaly; Clinical practice; Patient management; Guidelines
• ISSN: 1386-341X; 1573-7403
• DOI: 10.1007/s11102-019-01012-3

Aim
The ACROPRAXIS program aims to describe the management of acromegaly in Spain and provide guidance.
Methods
Ninety-three endocrinologists were organized into 13 panels to discuss the practical issues in managing acromegaly. Based on the key learnings, an online Delphi survey with 62 statements was performed, so those statements achieving consensus could be used as guidance. Statements were rated on a 9-point scale (9, full agreement; consensus > 66.6% of response in the same tertile).
Results
Ninety-two endocrinologists (98.8%) answered two rounds of the survey (mean age 47.6 years; 59.8% women; median 18.5 years of experience). Consensus was achieved for 49 (79%) statements.
Diagnosis
: The levels of insulin-like growth factor I (IGFI) is the preferred screening test. If IGFI levels 1–1.3 ULN, the test is repeated and growth hormone (GH) after oral glucose tolerance test (OGTT) is assessed. A pituitary magnetic resonance is performed after biochemical diagnosis.
Treatment
: Surgery is the first treatment choice for patients with microadenoma or macroadenoma with/without optical pathway compression. Pre-surgical somatostatin analogues (SSA) are indicated when surgery is delayed and/or to reduce anaesthesia-associated risks. After unsuccessful surgery, reintervention is performed if the residual tumor is resectable, while if non-resectable, SSA are administered.
Follow
-
up
First biochemical and clinical controls are performed 1–3 months after surgery. Disease remission is considered if random GH levels are < 1 µg/L or OGTT is < 1 or ≤ 0.4 µg/L, depending on the assay’s sensitivity.
Conclusion
Current clinical management for acromegaly is homogeneous across Spain and generally follows clinical guidelines.