Acromegaly management in the Nordic countries: A Delphi consensus survey
Arlien-Søborg, Mai C; Dal, Jakob; Heck, Ansgar; Stochholm, Kirstine; Husted, Eigil; Feltoft, Claus Larsen; Rasmussen, Åse Krogh; Feldt-Rasmussen, Ulla; Andreassen, Mikkel; Klose, Marianne Christina; Nielsen, Torben Leo; Andersen, Marianne Skovsager; Christensen, Louise Lehmann; Krogh, Jesper; Jarlov, Anne; Bollerslev, Jens; Nermoen, Ingrid; Oksnes, Marianne; Dahlqvist, Per; Olsson, Tommy; Berinder, Katarina; Hoybye, Charlotte; Petersson, Maria; Akerman, Anna-Karin; Wahlberg, Jeanette; Ekman, Bertil; Engstrom, Britt Eden; Johannsson, Gudmundur; Ragnarsson, Oskar; Olsson, Daniel; Sigurjónsdóttir, Helga Ágústa; Fougner, Stine Lyngvi; Matikainen, Niina; Vehkavaara, Satu; Metso, Saara; Jaatinen, Pia; Hämäläinen, Päivi; Rintamäki, Reeta; Yliaska, Iina; Immonen, Heidi; Mäkimattila, Sari; Cederberg-Tamminen, Henna; Viukari, Marianna; Nevalainen, Pasi; Nuutila, Pirjo; Schalin-Jäntti, Camilla; Burman, Pia; Jørgensen, Jens Otto Lunde (2024-06-12)
Wiley-Blackwell
12.06.2024
Arlien-Søborg MC, Dal J, Heck A, et al. Acromegaly management in the Nordic countries: a Delphi consensus survey. Clin Endocrinol (Oxf). 2024; 101: 263-273. doi:10.1111/cen.15095
https://creativecommons.org/licenses/by-nc-nd/4.0/
© 2024 The Author(s). Clinical Endocrinology published by John Wiley & Sons Ltd. This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial‐NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made
https://creativecommons.org/licenses/by-nc-nd/4.0/
© 2024 The Author(s). Clinical Endocrinology published by John Wiley & Sons Ltd. This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial‐NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made
https://creativecommons.org/licenses/by-nc-nd/4.0/
Julkaisun pysyvä osoite on
https://urn.fi/URN:NBN:fi:oulu-202406134487
https://urn.fi/URN:NBN:fi:oulu-202406134487
Tiivistelmä
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.
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.
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