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Consensus on criteria for acromegaly diagnosis and remission

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Giustina, Andrea, Biermasz, Nienke, Casanueva, Felipe F., Fleseriu, Maria, Mortini, Pietro, Strasburger, Christian, van der Lely, A. J., Wass, John, Melmed, Shlomo, Acromegaly Consensus Group, Banfi, Giuseppe, Barkan, Ariel, Beckers, Albert, Bidlingmaier, Martin, Boguszewski, Cesar, Brue, Thierry, Buchfelder, Michael, Chanson, Philippe, Chiloiro, Sabrina, Colao, Annamaria, Coopmans, Eva, Esposito, Daniela, Ferone, Diego, Frara, Stefano, Gadelha, Mônica, Geer, Eliza B., Ghigo, Ezio, Greenman, Yona, Gurnell, Mark, Ho, Ken, Ioachimescu, Adriana, Johannsson, Gudmundur, Jørgensen, Jens Otto, Kaiser, Ursula B., Karavitaki, Niki, Katznelson, Laurence, Lamberts, Stephen, Losa, Marco, Luger, Anton, Luque, Raúl, Maffei, Pietro, Marazuela, Mónica, Neggers, Sebastian, Pereira, Alberto, Persani, Luca, Petersenn, Stephan, Reincke, Martin, Salvatori, Roberto, Samson, Susan N., Schilbach, Katharina, Shimon, Ilan, Tsagarakis, Stylianos, Zatelli, Maria Chiara·2024·Pituitary
DOI 10.1007/s11102-023-01360-1
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Abstract

Purpose: The 14th Acromegaly Consensus Conference was convened to consider biochemical criteria for acromegaly diagnosis and evaluation of therapeutic efficacy. Methods: Fifty-six acromegaly experts from 16 countries reviewed and discussed current evidence focused on biochemical assays; criteria for diagnosis and the role of imaging, pathology, and clinical assessments; consequences of diagnostic delay; criteria for remission and recommendations for follow up; and the value of assessment and monitoring in defining disease progression, selecting appropriate treatments, and maximizing patient outcomes. Results: In a patient with typical acromegaly features, insulin-like growth factor (IGF)-I > 1.3 times the upper limit of normal for age confirms the diagnosis. Random growth hormone (GH) measured after overnight fasting may be useful for informing prognosis, but is not required for diagnosis. For patients with equivocal results, IGF-I measurements using the same validated assay can be repeated, and oral glucose tolerance testing might also be useful. Although biochemical remission is the primary assessment of treatment outcome, biochemical findings should be interpreted within the clinical context of acromegaly. Follow up assessments should consider biochemical evaluation of treatment effectiveness, imaging studies evaluating residual/recurrent adenoma mass, and clinical signs and symptoms of acromegaly, its complications, and comorbidities. Referral to a multidisciplinary pituitary center should be considered for patients with equivocal biochemical, pathology, or imaging findings at diagnosis, and for patients insufficiently responsive to standard treatment approaches. Conclusion: Consensus recommendations highlight new understandings of disordered GH and IGF-I in patients with acromegaly and the importance of expert management for this rare disease.

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Metadata

Authors
Giustina, A., Biermasz, N., Casanueva, F. F., Fleseriu, M., Mortini, P., Strasburger, C., van der Lely, A. J., Wass, J., Melmed, S., Acromegaly Consensus Group, Banfi, G., Barkan, A., Beckers, A., Bidlingmaier, M., Boguszewski, C., Brue, T., Buchfelder, M., Chanson, P., Chiloiro, S., Colao, A., Coopmans, E., Esposito, D., Ferone, D., Frara, S., Gadelha, M., Geer, E. B., Ghigo, E., Greenman, Y., Gurnell, M., Ho, K., Ioachimescu, A., Johannsson, G., Jørgensen, J. O., Kaiser, U. B., Karavitaki, N., Katznelson, L., Lamberts, S., Losa, M., Luger, A., Luque, R., Maffei, P., Marazuela, M., Neggers, S., Pereira, A., Persani, L., Petersenn, S., Reincke, M., Salvatori, R., Samson, S. N., Schilbach, K., Shimon, I., Tsagarakis, S., & Zatelli, M. C.
Venue
Pituitary
Publisher
Springer Science and Business Media LLC
Published
2023-11-03
Volume
27
Issue
1
Pages
7-22
ISSN
  • 1386-341X (ISSN-L)
  • 1573-7403
DOI
10.1007/s11102-023-01360-1
OpenAlex
W4388283521
Cited by
214
References
3
FWCI
35.41
Type
journal article
Language
en
Update notices
correction (2023-12-06)
Open access
hybrid
Licence
Funders
Cedars-Sinai Medical Center

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The paper
Giustina, A., Biermasz, N., Casanueva, F. F., Fleseriu, M., Mortini, P., Strasburger, C., van der Lely, A. J., Wass, J., Melmed, S., Acromegaly Consensus Group, Banfi, G., Barkan, A., Beckers, A., Bidlingmaier, M., Boguszewski, C., Brue, T., Buchfelder, M., Chanson, P., Chiloiro, S., . . . Zatelli, M. C. (2024). Consensus on criteria for acromegaly diagnosis and remission. Pituitary. https://doi.org/10.1007/s11102-023-01360-1

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