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. 2024 Sep;101(3):263-273.
doi: 10.1111/cen.15095. Epub 2024 Jun 12.

Acromegaly management in the Nordic countries: A Delphi consensus survey

Mai C Arlien-Søborg  1 , Jakob Dal  2   3 , Ansgar Heck  4 , Kirstine Stochholm  1 , Eigil Husted  2 , Claus Larsen Feltoft  5 , Åse Krogh Rasmussen  6 , Ulla Feldt-Rasmussen  6 , Mikkel Andreassen  6 , Marianne Christina Klose  6 , Torben Leo Nielsen  7 , Marianne Skovsager Andersen  7 , Louise Lehmann Christensen  7 , Jesper Krogh  6 , Anne Jarlov  6 , Jens Bollerslev  4 , Ingrid Nermoen  8 , Marianne Oksnes  9 , Per Dahlqvist  10 , Tommy Olsson  10 , Katarina Berinder  11 , Charlotte Hoybye  11 , Maria Petersson  11 , Anna-Karin Akerman  12   13 , Jeanette Wahlberg  13 , Bertil Ekman  14 , Britt Eden Engstrom  15 , Gudmundur Johannsson  16   17 , Oskar Ragnarsson  16 , Daniel Olsson  16   17   18 , Helga Ágústa Sigurjónsdóttir  19   20 , Stine Lyngvi Fougner  21   22 , Niina Matikainen  23 , Satu Vehkavaara  23 , Saara Metso  24 , Pia Jaatinen  24 , Päivi Hämäläinen  24 , Reeta Rintamäki  25 , Iina Yliaska  26 , Heidi Immonen  27 , Sari Mäkimattila  23 , Henna Cederberg-Tamminen  23 , Marianna Viukari  23 , Pasi Nevalainen  24 , Pirjo Nuutila  27 , Camilla Schalin-Jäntti  23 , Pia Burman  28 , Jens Otto Lunde Jørgensen  1
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Free article

Acromegaly management in the Nordic countries: A Delphi consensus survey

Mai C Arlien-Søborg et al. Clin Endocrinol (Oxf). 2024 Sep.
Free article

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.

Keywords: Delphi; acromegaly; dopamine agonist; growth hormone; growth hormone receptor antagonist; insulin‐like growth factor i; somatostatin.

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References

REFERENCES

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