Consensus on criteria for acromegaly diagnosis and remissionстатья из журнала
Аннотация: 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.
Год издания: 2023
Авторы: Andrea Giustina, Nienke R. Biermasz, Felipe F. Casanueva, Maria Fleseriu, Pietro Mortini, Christian J. Strasburger, A. J. van der Lely, John Wass, Шломо Мелмед, Giuseppe Banfi, Ariel L. Barkan, Albert Beckers, Martin Bidlingmaier, Cesar Boguszewski, Thierry Brue, Michael Buchfelder, Philippe Chanson, Sabrina Chiloiro, Annamaria Colao, Eva C Coopmans, Daniela Espósito, Diego Ferone, Stefano Frara, Mônica R. Gadelha, Eliza B. Geer, Ezio Ghigo, Yona Greenman, Mark Gurnell, Ken K. Y. Ho, Adriana G. Ioachimescu, Gudmundur Johannsson, Jens Otto Lunde Jørgensen, Ursula B. Kaiser, Niki Karavitaki, Laurence Katznelson, Stephen Lamberts, Marco Losa, Anton Luger, Raúl Luque, Pietro Maffei, Mónica Marazuela, Sebastian Neggers, Alberto M. Pereira, Luca Persani, Stephan Petersenn, Martín Reincke, Roberto Salvatori, Susan N. Samson, Katharina Schilbach, Ilan Shimon, Stylianos Tsagarakis, Maria Chiara Zatelli
Издательство: Springer Science+Business Media
Источник: Pituitary
Ключевые слова: Pituitary Gland Disorders and Treatments, Growth Hormone and Insulin-like Growth Factors, Adrenal and Paraganglionic Tumors
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