Review

. 2020 Dec;21(4):667-678.

doi: 10.1007/s11154-020-09588-z. Epub 2020 Sep 10.

Multidisciplinary management of acromegaly: A consensus

Andrea Giustina¹, Garni Barkhoudarian², Albert Beckers³, Anat Ben-Shlomo⁴, Nienke Biermasz⁵, Beverly Biller⁶, Cesar Boguszewski⁷, Marek Bolanowski⁸, Jens Bollerslev⁹, Vivien Bonert⁴, Marcello D Bronstein¹⁰, Michael Buchfelder¹¹, Felipe Casanueva¹², Philippe Chanson¹³, David Clemmons¹⁴, Maria Fleseriu¹⁵, Anna Maria Formenti¹⁶, Pamela Freda¹⁷, Monica Gadelha¹⁸, Eliza Geer¹⁹, Mark Gurnell²⁰, Anthony P Heaney²¹, Ken K Y Ho²², Adriana G Ioachimescu²³, Steven Lamberts²⁴, Edward Laws²⁵, Marco Losa²⁶, Pietro Maffei²⁷, Adam Mamelak⁴, Moises Mercado²⁸, Mark Molitch²⁹, Pietro Mortini²⁶, Alberto M Pereira⁵, Stephan Petersenn³⁰, Kalmon Post³¹, Manuel Puig-Domingo³², Roberto Salvatori³³, Susan L Samson³⁴, Ilan Shimon³⁵, Christian Strasburger³⁶, Brooke Swearingen³⁷, Peter Trainer³⁸, Mary L Vance³⁹, John Wass⁴⁰, Margaret E Wierman⁴¹, Kevin C J Yuen⁴², Maria Chiara Zatelli⁴³, Shlomo Melmed⁴

Affiliations

¹ Institute of Endocrine and Metabolic Sciences, San Raffaele Vita-Salute University, IRCCS San Raffaele Hospital, Ospedale San Raffaele, Via Olgettina, 58, 20132, Milan, Italy. giustina.andrea@hsr.it.
² Pacific Pituitary Disorders Center, Pacific Neuroscience Institute, Santa Monica, CA, USA.
³ Department of Endocrinology, University of Liège, Liège, Belgium.
⁴ Pituitary Center, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
⁵ Division of Endocrinology and Center for Endocrine Tumors, Department of Medicine, Leiden University Medical Center, Leiden, The Netherlands.
⁶ Neuroendocrine Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
⁷ SEMPR, Endocrine Division, Department of Internal Medicine, Federal University of Parana, Curitiba, Brazil.
⁸ Department of Endocrinology, Diabetes and Isotope Therapy, Wroclaw Medical University, Wroclaw, Poland.
⁹ Section of Specialized Endocrinology, Department of Endocrinology, University of Oslo, Oslo, Norway.
¹⁰ Neuroendocrine Unit, Division of Endocrinology and Metabolism, Hospital das Clinicas, University of Sao Paulo, Sao Paulo, Brazil.
¹¹ Department of Neurosurgery, University Hospital Erlangen, Erlangen, Germany.
¹² Division of Endocrinology, Santiago de Compostela University and Ciber OBN, Santiago de Compostela, Spain.
¹³ Centre de Référence des Maladies Rares de l'Hypophyse and Université Paris-Saclay, Univ. Paris-Sud, Inserm, Signalisation Hormonale, Physiopathologie Endocrinienne et Métabolique, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, Le Kremlin-Bicêtre, Paris, France.
¹⁴ Department of Medicine, University of North Carolina, Chapel Hill, NC, USA.
¹⁵ Departments of Medicine and Neurological Surgery, Pituitary Center, Oregon Health & Science University, Portland, Oregon, USA.
¹⁶ Institute of Endocrine and Metabolic Sciences, San Raffaele Vita-Salute University, IRCCS San Raffaele Hospital, Ospedale San Raffaele, Via Olgettina, 58, 20132, Milan, Italy.
¹⁷ Department of Medicine, Columbia University, Vagelos College of Physicians and Surgeons, New York, NY, USA.
¹⁸ Neuroendocrinology Research Center/Endocrinology Section, Medical School and Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
¹⁹ Multidisciplinary Pituitary and Skull Base Tumor Center, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
²⁰ Metabolic Research Laboratories, Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge and NIHR Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge, UK.
²¹ Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
²² The Garvan Institute of Medical Research, St. Vincent's Hospital, University of New South Wales, Sydney, Australia.
²³ Department of Neurosurgery and Medicine, Division of Endocrinology, Metabolism and Lipids, Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA, USA.
²⁴ Erasmus Medical Center, Rotterdam, The Netherlands.
²⁵ Pituitary/Neuroendocrine Center, Brigham & Women's Hospital, Boston, MA, USA.
²⁶ Department of Neurosurgery, San Raffaele University Health Institute Milan, Milan, Italy.
²⁷ Department of Medicine, Padua University Hospital, Padua, Italy.
²⁸ Medical Research Unit in Endcrine Diseases, Hospital de Especialidades, Centro Médico Nacional, Siglo XXI, IMSS, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico.
²⁹ Division of Endocrinology, Metabolism & Molecular Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
³⁰ ENDOC Center for Endocrine Tumors, Hamburg, Germany.
³¹ Department of Neurosurgery, Medicine, Mount Sinai Health System, New York, NY, USA.
³² Germans Trias i Pujol Research Institute, Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain.
³³ Division of Endocrinology, Diabetes, and Metabolism and Pituitary Center, Johns Hopkins School of Medicine, Baltimore, MD, USA.
³⁴ Departments of Medicine and Neurosurgery, Baylor St. Luke's Pituitary Center, Baylor College of Medicine, Houson, TX, USA.
³⁵ Endocrine Institute, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel.
³⁶ Department of Medicine for Endocrinology, Diabetes and Nutritional Medicine, Charité Universitätsmedizin, Berlin, Germany.
³⁷ Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, USA.
³⁸ Department of Endocrinology, The Christie NHS Foundation Trust, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.
³⁹ Department of Medicine, University of Virginia, Charlottesville, VA, USA.
⁴⁰ Department of Endocrinology, Oxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, Oxford, UK.
⁴¹ Pituitary, Adrenal and Neuroendocrine Tumor Program, Department of Medicine, University of Colorado Anschutz Medical Center, Aurora, CO, USA.
⁴² Barrow Pituitary Center and Neuroendocrinology Clinic, Barrow Neurological Institute, University of Arizona College of Medicine, Creighton School of Medicine, Phoenix, AZ, USA.
⁴³ Section of Endocrinology & Internal Medicine, Department of Medical Sciences, University of Ferrara, Ferrara, Italy.

PMID: 32914330
PMCID: PMC7942783
DOI: 10.1007/s11154-020-09588-z

Review

Multidisciplinary management of acromegaly: A consensus

Andrea Giustina et al. Rev Endocr Metab Disord. 2020 Dec.

. 2020 Dec;21(4):667-678.

doi: 10.1007/s11154-020-09588-z. Epub 2020 Sep 10.

Authors

Affiliations

¹ Institute of Endocrine and Metabolic Sciences, San Raffaele Vita-Salute University, IRCCS San Raffaele Hospital, Ospedale San Raffaele, Via Olgettina, 58, 20132, Milan, Italy. giustina.andrea@hsr.it.
² Pacific Pituitary Disorders Center, Pacific Neuroscience Institute, Santa Monica, CA, USA.
³ Department of Endocrinology, University of Liège, Liège, Belgium.
⁴ Pituitary Center, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
⁵ Division of Endocrinology and Center for Endocrine Tumors, Department of Medicine, Leiden University Medical Center, Leiden, The Netherlands.
⁶ Neuroendocrine Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
⁷ SEMPR, Endocrine Division, Department of Internal Medicine, Federal University of Parana, Curitiba, Brazil.
⁸ Department of Endocrinology, Diabetes and Isotope Therapy, Wroclaw Medical University, Wroclaw, Poland.
⁹ Section of Specialized Endocrinology, Department of Endocrinology, University of Oslo, Oslo, Norway.
¹⁰ Neuroendocrine Unit, Division of Endocrinology and Metabolism, Hospital das Clinicas, University of Sao Paulo, Sao Paulo, Brazil.
¹¹ Department of Neurosurgery, University Hospital Erlangen, Erlangen, Germany.
¹² Division of Endocrinology, Santiago de Compostela University and Ciber OBN, Santiago de Compostela, Spain.
¹³ Centre de Référence des Maladies Rares de l'Hypophyse and Université Paris-Saclay, Univ. Paris-Sud, Inserm, Signalisation Hormonale, Physiopathologie Endocrinienne et Métabolique, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, Le Kremlin-Bicêtre, Paris, France.
¹⁴ Department of Medicine, University of North Carolina, Chapel Hill, NC, USA.
¹⁵ Departments of Medicine and Neurological Surgery, Pituitary Center, Oregon Health & Science University, Portland, Oregon, USA.
¹⁶ Institute of Endocrine and Metabolic Sciences, San Raffaele Vita-Salute University, IRCCS San Raffaele Hospital, Ospedale San Raffaele, Via Olgettina, 58, 20132, Milan, Italy.
¹⁷ Department of Medicine, Columbia University, Vagelos College of Physicians and Surgeons, New York, NY, USA.
¹⁸ Neuroendocrinology Research Center/Endocrinology Section, Medical School and Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
¹⁹ Multidisciplinary Pituitary and Skull Base Tumor Center, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
²⁰ Metabolic Research Laboratories, Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge and NIHR Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge, UK.
²¹ Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
²² The Garvan Institute of Medical Research, St. Vincent's Hospital, University of New South Wales, Sydney, Australia.
²³ Department of Neurosurgery and Medicine, Division of Endocrinology, Metabolism and Lipids, Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA, USA.
²⁴ Erasmus Medical Center, Rotterdam, The Netherlands.
²⁵ Pituitary/Neuroendocrine Center, Brigham & Women's Hospital, Boston, MA, USA.
²⁶ Department of Neurosurgery, San Raffaele University Health Institute Milan, Milan, Italy.
²⁷ Department of Medicine, Padua University Hospital, Padua, Italy.
²⁸ Medical Research Unit in Endcrine Diseases, Hospital de Especialidades, Centro Médico Nacional, Siglo XXI, IMSS, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico.
²⁹ Division of Endocrinology, Metabolism & Molecular Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
³⁰ ENDOC Center for Endocrine Tumors, Hamburg, Germany.
³¹ Department of Neurosurgery, Medicine, Mount Sinai Health System, New York, NY, USA.
³² Germans Trias i Pujol Research Institute, Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain.
³³ Division of Endocrinology, Diabetes, and Metabolism and Pituitary Center, Johns Hopkins School of Medicine, Baltimore, MD, USA.
³⁴ Departments of Medicine and Neurosurgery, Baylor St. Luke's Pituitary Center, Baylor College of Medicine, Houson, TX, USA.
³⁵ Endocrine Institute, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel.
³⁶ Department of Medicine for Endocrinology, Diabetes and Nutritional Medicine, Charité Universitätsmedizin, Berlin, Germany.
³⁷ Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, USA.
³⁸ Department of Endocrinology, The Christie NHS Foundation Trust, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.
³⁹ Department of Medicine, University of Virginia, Charlottesville, VA, USA.
⁴⁰ Department of Endocrinology, Oxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, Oxford, UK.
⁴¹ Pituitary, Adrenal and Neuroendocrine Tumor Program, Department of Medicine, University of Colorado Anschutz Medical Center, Aurora, CO, USA.
⁴² Barrow Pituitary Center and Neuroendocrinology Clinic, Barrow Neurological Institute, University of Arizona College of Medicine, Creighton School of Medicine, Phoenix, AZ, USA.
⁴³ Section of Endocrinology & Internal Medicine, Department of Medical Sciences, University of Ferrara, Ferrara, Italy.

PMID: 32914330
PMCID: PMC7942783
DOI: 10.1007/s11154-020-09588-z

Abstract

The 13th Acromegaly Consensus Conference was held in November 2019 in Fort Lauderdale, Florida, and comprised acromegaly experts including endocrinologists and neurosurgeons who considered optimal approaches for multidisciplinary acromegaly management. Focused discussions reviewed techniques, results, and side effects of surgery, radiotherapy, and medical therapy, and how advances in technology and novel techniques have changed the way these modalities are used alone or in combination. Effects of treatment on patient outcomes were considered, along with strategies for optimizing and personalizing therapeutic approaches. Expert consensus recommendations emphasize how best to implement available treatment options as part of a multidisciplinary approach at Pituitary Tumor Centers of Excellence.

Keywords: Acromegaly; Consensus; Medical therapy; Multidisciplinary management; Pituitary tumor centers of excellence; Radiotherapy; Surgery.

PubMed Disclaimer

Conflict of interest statement

Conflicts of interest/competing interests AG is consultant for Chiasma, Genevant, Ipsen, Pfizer and Recordati and received research grants from Ipsen, Novartis and Pfizer to his Institution.

AB has received research funding from Pfizer and travel and speaker grants from Novartis and Ipsen.

BMKB is PI of research support to Massachsuetts General Hospital from Crinetics, Ionis and Novartis, occasional consulting honoraria from Chiasma, Crinetics and Novartis.

CLB has served as consultant/speaker for Novartis and Ipsen.

MB has served as speaker for Novartis, Ipsen, Pfizer and Recordati.

VB has received research grants from Pfizer, and has served on advisory boards for Pfizer.

MDB is Member of Steering Committees and Advisory Boards of Chiasma, Ipsen, Novartis; Speaker for Ipsen, Novartis; and has received grants as PI for clinical trials from Crinetics, Ipsen, and Novartis.

PC has received unrestricted research and educational grants from Ipsen, Novartis, Crinetics and Pfizer on behalf of the Service of Endocrinology and Reproductive Diseases, Hôpitaux Universitaires Paris-Saclay and Association Recherche Endocrinologie Bicêtre, and has served as investigator (principal or coordinator) for clinical trials funded by Novartis, Pfizer, Ipsen, Italpharmaco, Chiasma. PC gave lectures for Ipsen, Novartis, and Pfizer. All the fees and honoraria are paid to his Institution or Research Association.

DC served as an advisory board member for Crinetics.

MF has received research support to OHSU as principal investigator from Chiasma, Crinetics, Ionis, Novartis and has received occasional scientific consulting from Chiasma, Crinetics, Ionis, Novartis, Pfizer.

PUF has received research grant to her institution for clinical research studies from Pfizer, Novartis, Ipsen and Chiasma.

MRG has been principal investigator in clinical trials from Novartis and Crinectics, has served on advisory boards for Novartis and Crinectics and served as apeaker for Novatis and Ipsen.

EBG is an investigator for research grants to MSKCC from Ionis, Novartis, Corcept, Strongbridge Biopharma, and Bristol-Myers Squibb.

She has received a speaker’s fee for an educational presentaion for Chiasma.

APH has served as consultant/ speaker for Ipsen and Chiasma.

AGI has received institution-directed research grants from Chiasma, Strongbridge and Novartis and served as consultant for Tiburio.

PM received consultation or speaker fee, support for congress participation, and contribution to research projects from by Pfizer, Novartis, and Ipsen.

MEM received research support from Chiasma, Novartis, Ionis, and Crinetics.

SP has served as an advisory board member for Ipsen, Novartis, and Crinetics, and as speaker for Ipsen, Novartis, and Pfizer.

MPD has recived research grants from Pfizer and Novartis, has served on advisory boards for Pfizer, Novartis and Ipsen, and served as speaker for Novartis, Ipsen and Pfizer.

RS received support for educational activities at Johns Hopkins University from Pfizer and support clinical trials from Chiasma, Crinetics and Novartis.

SLS has served as an advisor and/or investigator for Novartis, Chiasma, Pfizer, and Ipsen, and has received investigator-initiated funding from Novartis.

IS has served as consultant and speaker for Novartis, Pfizer and Medison Pharma.

CS served as an advisor to and received speaker’s fees from Pfizer, Ipsen, Chiasma and Crinetics.

PT serves on advisory boards for Novartis, Crinetics, Chiasma and has received research funding to support clinical trials from Novartis, Crinetics, Chiasma, Strongbridge, Camarus. All honoraria and reseach income is administered by his institution.

MEW has received research grants to her institution for clinical research studies from Ionis and reviewed investigator-initiated research proposals for Pfizer.

KCJY has received research grants to his institution for clinical research studies from Ionis, Crinetics, and Novartis, and has served on advisory boards for Pfizer, and Ipsen.

MCZ received consulting fees from Novartis and Ipsen.

SM has received consulting fees from Chiasma, Crinetics, Ionis, Ipsen and research grants to the institution from Pfizer.

GB, ABS, NB, JB, MB, FC, AMF, MG, KKYH, SL, EL, ML, AM, MM, PM, MP, KP, BS, MLV, and JW have no conflict of interests to declare.

Figures

**Fig. 1. Algorithm for the Multidisciplinary Management of Acromegaly.**
a If curative surgery is not feasible; b Consider in cases of mild postoperative GH/IGF-I elevations. Well controlled defined as normalized GH/IGF-I; not controlled defined as other than well-controlled. Abbreviations: IGF-I, insulin-like growth factor- I; SRL, somatostatin receptor ligand octreotide or lanreotide

See this image and copyright information in PMC

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Multidisciplinary management of acromegaly: A consensus

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Multidisciplinary management of acromegaly: A consensus

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Conflict of interest statement

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