Acromegaly management in the Nordic countries: A Delphi consensus survey
(2024) In Clinical Endocrinology 101(3). p.263-273- 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... (More)
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.
(Less)
- author
- organization
- publishing date
- 2024-09
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- acromegaly, Delphi, dopamine agonist, growth hormone, growth hormone receptor antagonist, insulin-like growth factor i, somatostatin
- in
- Clinical Endocrinology
- volume
- 101
- issue
- 3
- pages
- 11 pages
- publisher
- Wiley-Blackwell
- external identifiers
-
- pmid:38865284
- scopus:85195918201
- ISSN
- 0300-0664
- DOI
- 10.1111/cen.15095
- language
- English
- LU publication?
- yes
- id
- 172829bd-48cc-4271-95d8-3e6ddcd3d50a
- date added to LUP
- 2024-09-11 14:07:14
- date last changed
- 2024-09-11 14:08:30
@article{172829bd-48cc-4271-95d8-3e6ddcd3d50a,
abstract = {{<p>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.</p>}},
author = {{Arlien-Søborg, Mai C. and Dal, Jakob and Heck, Ansgar and Stochholm, Kirstine and Husted, Eigil and Feltoft, Claus Larsen and Rasmussen, Åse Krogh and Feldt-Rasmussen, Ulla and Andreassen, Mikkel and Klose, Marianne Christina and Nielsen, Torben Leo and Andersen, Marianne Skovsager and Christensen, Louise Lehmann and Krogh, Jesper and Jarlov, Anne and Bollerslev, Jens and Nermoen, Ingrid and Oksnes, Marianne and Dahlqvist, Per and Olsson, Tommy and Berinder, Katarina and Hoybye, Charlotte and Petersson, Maria and Akerman, Anna karin and Wahlberg, Jeanette and Ekman, Bertil and Engstrom, Britt Eden and Johannsson, Gudmundur and Ragnarsson, Oskar and Olsson, Daniel and Sigurjónsdóttir, Helga Ágústa and Fougner, Stine Lyngvi and Matikainen, Niina and Vehkavaara, Satu and Metso, Saara and Jaatinen, Pia and Hämäläinen, Päivi and Rintamäki, Reeta and Yliaska, Iina and Immonen, Heidi and Mäkimattila, Sari and Cederberg-Tamminen, Henna and Viukari, Marianna and Nevalainen, Pasi and Nuutila, Pirjo and Schalin-Jäntti, Camilla and Burman, Pia and Jørgensen, Jens Otto Lunde}},
issn = {{0300-0664}},
keywords = {{acromegaly; Delphi; dopamine agonist; growth hormone; growth hormone receptor antagonist; insulin-like growth factor i; somatostatin}},
language = {{eng}},
number = {{3}},
pages = {{263--273}},
publisher = {{Wiley-Blackwell}},
series = {{Clinical Endocrinology}},
title = {{Acromegaly management in the Nordic countries: A Delphi consensus survey}},
url = {{http://dx.doi.org/10.1111/cen.15095}},
doi = {{10.1111/cen.15095}},
volume = {{101}},
year = {{2024}},
}