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Pituitary
Published in: Pituitary 4/2016

Open Access 01-08-2016

Challenges in the diagnosis and management of acromegaly: a focus on comorbidities

Authors: Alin Abreu, Alejandro Pinzón Tovar, Rafael Castellanos, Alex Valenzuela, Claudia Milena Gómez Giraldo, Alejandro Castellanos Pinedo, Doly Pantoja Guerrero, Carlos Alfonso Builes Barrera, Humberto Ignacio Franco, Antônio Ribeiro-Oliveira Jr., Lucio Vilar, Raquel S. Jallad, Felipe Gaia Duarte, Mônica Gadelha, Cesar Luiz Boguszewski, Julio Abucham, Luciana A. Naves, Nina Rosa C. Musolino, Maria Estela Justamante de Faria, Ciliana Rossato, Marcello D. Bronstein

Published in: Pituitary | Issue 4/2016

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Abstract

Introduction

Acromegaly is a rare, insidious disease resulting from the overproduction of growth hormone (GH) and insulin-like growth factor 1 (IGF-1), and is associated with a range of comorbidities. The extent of associated complications and mortality risk is related to length of exposure to the excess GH and IGF-1, thus early diagnosis and treatment is imperative. Unfortunately, acromegaly is often diagnosed late, when patients already have a wide range of comorbidities. The presence of comorbid conditions contributes significantly to patient morbidity/mortality and impaired quality of life.

Methods

We conducted a retrospective literature review for information relating to the diagnosis of acromegaly, and its associated comorbidities using PubMed. The main aim of this review is to highlight the issues of comorbidities in acromegaly, and to reinforce the importance of early diagnosis and treatment.

Findings and conclusions

Successful management of acromegaly goes beyond treating the disease itself, since many patients are diagnosed late in disease evolution, they present with a range of comorbid conditions, such as cardiovascular disease, diabetes, hypertension, and sleep apnea. It is important that patients are screened carefully at diagnosis (and thereafter), for common associated complications, and that biochemical control does not become the only treatment goal. Mortality and morbidities in acromegaly can be reduced successfully if patients are treated using a multimodal approach with comprehensive comorbidity management.
Literature
1.
Adelman DT, Liebert KJ, Nachtigall LB, Lamerson M, Bakker B (2013) Acromegaly: the disease, its impact on patients, and managing the burden of long-term treatment. Int J Gen Med 6:31–38CrossRefPubMedPubMedCentral
2.
3.
Schneider HJ, Sievers C, Saller B, Wittchen HU, Stalla GK (2008) High prevalence of biochemical acromegaly in primary care patients with elevated IGF-1 levels. Clin Endocrinol (Oxf) 69(3):432–435CrossRef
4.
Fernandez A, Karavitaki N, Wass JA (2010) Prevalence of pituitary adenomas: a community-based, cross-sectional study in Banbury (Oxfordshire, UK). Clin Endocrinol (Oxf) 72(3):377–382CrossRef
5.
Ben-Shlomo A, Sheppard MC, Stephens JM, Pulgar S, Melmed S (2011) Clinical, quality of life, and economic value of acromegaly disease control. Pituitary 14(3):284–294CrossRefPubMedPubMedCentral
6.
7.
Rajasoorya C, Holdaway IM, Wrightson P, Scott DJ, Ibbertson HK (1994) Determinants of clinical outcome and survival in acromegaly. Clin Endocrinol (Oxf) 41(1):95–102CrossRef
8.
Nachtigall L, Delgado A, Swearingen B, Lee H, Zerikly R, Klibanski A (2008) Changing patterns in diagnosis and therapy of acromegaly over two decades. J Clin Endocrinol Metab 93(6):2035–2041CrossRefPubMed
9.
Reid TJ, Post KD, Bruce JN, Nabi Kanibir M, Reyes-Vidal CM, Freda PU (2010) Features at diagnosis of 324 patients with acromegaly did not change from 1981 to 2006: acromegaly remains under-recognized and under-diagnosed. Clin Endocrinol (Oxf) 72(2):203–208CrossRef
10.
Colao A, Ferone D, Marzullo P, Lombardi G (2004) Systemic complications of acromegaly: epidemiology, pathogenesis, and management. Endocr Rev 25(1):102–152CrossRefPubMed
11.
Holdaway IM, Rajasoorya RC, Gamble GD (2004) Factors influencing mortality in acromegaly. J Clin Endocrinol Metab 89(2):667–674CrossRefPubMed
12.
13.
Siegel S, Streetz-van der Werf C, Schott JS, Nolte K, Karges W, Kreitschmann-Andermahr I (2013) Diagnostic delay is associated with psychosocial impairment in acromegaly. Pituitary 16(4):507–514CrossRefPubMed
14.
Szczesniak D, Jawiarczyk-Przybylowska A, Rymaszewska J (2015) The quality of life and psychological, social and cognitive functioning of patients with acromegaly. Adv Clin Exp Med 24(1):167–172CrossRefPubMed
15.
Clemmons DR (2011) Clinical laboratory indices in the treatment of acromegaly. Clin Chim Acta 412(5–6):403–409CrossRefPubMed
16.
Clemmons DR (2011) Consensus statement on the standardization and evaluation of growth hormone and insulin-like growth factor assays. Clin Chem 57(4):555–559CrossRefPubMed
17.
Freda PU, Beckers AM, Katznelson L, Molitch ME, Montori VM, Post KD, Vance ML, Endocrine S (2011) Pituitary incidentaloma: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 96(4):894–904CrossRefPubMed
18.
Schneider HJ, Kosilek RP, Gunther M, Roemmler J, Stalla GK, Sievers C, Reincke M, Schopohl J, Wurtz RP (2011) A novel approach to the detection of acromegaly: accuracy of diagnosis by automatic face classification. J Clin Endocrinol Metab 96(7):2074–2080CrossRefPubMed
19.
Sabino SM, Miranda PA, Ribeiro-Oliveira A Jr (2010) Growth hormone-secreting pituitary adenomas: from molecular basis to treatment options in acromegaly. Cancer Biol Ther 9(7):483–492CrossRefPubMed
20.
Ribeiro-Oliveira A Jr, Barkan A (2012) The changing face of acromegaly—advances in diagnosis and treatment. Nat Rev Endocrinol 8(10):605–611CrossRefPubMed
21.
22.
Drange MR, Fram NR, Herman-Bonert V, Melmed S (2000) Pituitary tumor registry: a novel clinical resource. J Clin Endocrinol Metab 85(1):168–174PubMed
23.
Giustina A, Chanson P, Bronstein MD, Kilbanski A, Lamberts S, Casanueva FF, Trainer P, Ghigo E, Ho K, Melmed S, Acromegaly Consensus Group (2010) A consensus on criteria for cure of acromegaly. J Clin Endocrinol Metab 95(7):3141–3148CrossRefPubMed
24.
25.
Prencipe N, Floriani I, Guaraldi F, Di Giacomo SV, Cannavo S, Arnaldi G, Berton A, Torri V, Spinello M, Arvat E, Ghigo E, Grottoli S (2016) ACROSCORE: a new and simple tool for the diagnosis of acromegaly, a rare and underdiagnosed disease. Clin Endocrinol 84(3):380–385CrossRef
26.
Bihan H, Espinosa C, Valdes-Socin H, Salenave S, Young J, Levasseur S, Assayag P, Beckers A, Chanson P (2004) Long-term outcome of patients with acromegaly and congestive heart failure. J Clin Endocrinol Metab 89(11):5308–5313CrossRefPubMed
27.
Bondanelli M, Ambrosio MR, degli Uberti EC (2001) Pathogenesis and prevalence of hypertension in acromegaly. Pituitary 4(4):239–249CrossRefPubMed
28.
Vitale G, Pivonello R, Auriemma RS, Guerra E, Milone F, Savastano S, Lombardi G, Colao A (2005) Hypertension in acromegaly and in the normal population: prevalence and determinants. Clin Endocrinol (Oxf) 63(4):470–476CrossRef
29.
Katznelson L, Atkinson JL, Cook DM, Ezzat SZ, Hamrahian AH, Miller KK (2011) American association of clinical endocrinologists medical guidelines for clinical practice for the diagnosis and treatment of acromegaly—2011 update. Endocr Pract 17(Suppl 4):1–44CrossRefPubMed
30.
James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J, Lackland DT, LeFevre ML, MacKenzie TD, Ogedegbe O, Smith SC Jr, Svetkey LP, Taler SJ, Townsend RR, Wright JT Jr, Narva AS, Ortiz E (2014) 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA 311(5):507–520CrossRefPubMed
31.
Colao A, Spiezia S, Cerbone G, Pivonello R, Marzullo P, Ferone D, Di Somma C, Assanti AP, Lombardi G (2001) Increased arterial intima-media thickness by B-M mode echodoppler ultrasonography in acromegaly. Clin Endocrinol (Oxf) 54(4):515–524CrossRef
32.
Paisley AN, Banerjee M, Rezai M, Schofield RE, Balakrishnannair S, Herbert A, Lawrance JA, Trainer PJ, Cruickshank JK (2011) Changes in arterial stiffness but not carotid intimal thickness in acromegaly. J Clin Endocrinol Metab 96(5):1486–1492CrossRefPubMed
33.
Akutsu H, Kreutzer J, Wasmeier G, Ropers D, Rost C, Mohlig M, Wallaschofski H, Buchfelder M, Schofl C (2010) Acromegaly per se does not increase the risk for coronary artery disease. Eur J Endocrinol 162(5):879–886CrossRefPubMed
34.
Cannavo S, Almoto B, Cavalli G, Squadrito S, Romanello G, Vigo MT, Fiumara F, Benvenga S, Trimarchi F (2006) Acromegaly and coronary disease: an integrated evaluation of conventional coronary risk factors and coronary calcifications detected by computed tomography. J Clin Endocrinol Metab 91(10):3766–3772CrossRefPubMed
35.
Maison P, Tropeano AI, Macquin-Mavier I, Giustina A, Chanson P (2007) Impact of somatostatin analogs on the heart in acromegaly: a metaanalysis. J Clin Endocrinol Metab 92(5):1743–1747CrossRefPubMed
36.
De Marinis L, Bianchi A, Mazziotti G, Mettimano M, Milardi D, Fusco A, Cimino V, Maira G, Pontecorvi A, Giustina A (2008) The long-term cardiovascular outcome of different GH-lowering treatments in acromegaly. Pituitary 11(1):13–20CrossRefPubMed
37.
De Martino MC, Auriemma RS, Brevetti G, Vitale G, Schiano V, Galdiero M, Grasso L, Lombardi G, Colao A, Pivonello R (2010) The treatment with growth hormone receptor antagonist in acromegaly: effect on vascular structure and function in patients resistant to somatostatin analogues. J Endocrinol Investig 33(9):663–670CrossRef
38.
Jaffrain-Rea ML, Minniti G, Moroni C, Esposito V, Ferretti E, Santoro A, Infusino T, Tamburrano G, Cantore G, Cassone R (2003) Impact of successful transsphenoidal surgery on cardiovascular risk factors in acromegaly. Eur J Endocrinol 148(2):193–201CrossRefPubMed
39.
Grunstein RR, Ho KY, Berthon-Jones M, Stewart D, Sullivan CE (1994) Central sleep apnea is associated with increased ventilatory response to carbon dioxide and hypersecretion of growth hormone in patients with acromegaly. Am J Respir Crit Care Med 150(2):496–502CrossRefPubMed
40.
van Haute FR, Taboada GF, Correa LL, Lima GA, Fontes R, Riello AP, Dominici M, Gadelha MR (2008) Prevalence of sleep apnea and metabolic abnormalities in patients with acromegaly and analysis of cephalometric parameters by magnetic resonance imaging. Eur J Endocrinol 158(4):459–465CrossRefPubMed
41.
Ip MS, Lam B, Ng MM, Lam WK, Tsang KW, Lam KS (2002) Obstructive sleep apnea is independently associated with insulin resistance. Am J Respir Crit Care Med 165(5):670–676CrossRefPubMed
42.
Stoohs RA, Facchini F, Guilleminault C (1996) Insulin resistance and sleep-disordered breathing in healthy humans. Am J Respir Crit Care Med 154(1):170–174CrossRefPubMed
43.
44.
Attal P, Chanson P (2010) Endocrine aspects of obstructive sleep apnea. J Clin Endocrinol Metab 95(2):483–495CrossRefPubMed
45.
Kuhn E, Maione L, Bouchachi A, Roziere M, Salenave S, Brailly-Tabard S, Young J, Kamenicky P, Assayag P, Chanson P (2015) Long-term effects of pegvisomant on comorbidities in patients with acromegaly: a retrospective single-center study. Eur J Endocrinol 173(5):693–702CrossRefPubMedPubMedCentral
46.
Melmed S, Casanueva FF, Klibanski A, Bronstein MD, Chanson P, Lamberts SW, Strasburger CJ, Wass JA, Giustina A (2013) A consensus on the diagnosis and treatment of acromegaly complications. Pituitary 16(3):294–302CrossRefPubMed
47.
Rokkas T, Pistiolas D, Sechopoulos P, Margantinis G, Koukoulis G (2008) Risk of colorectal neoplasm in patients with acromegaly: a meta-analysis. World J Gastroenterol 14(22):3484–3489CrossRefPubMedPubMedCentral
48.
Renehan AG, O’Connell J, O’Halloran D, Shanahan F, Potten CS, O’Dwyer ST, Shalet SM (2003) Acromegaly and colorectal cancer: a comprehensive review of epidemiology, biological mechanisms, and clinical implications. Horm Metab Res 35(11–12):712–725PubMed
49.
Cats A, Dullaart RP, Kleibeuker JH, Kuipers F, Sluiter WJ, Hardonk MJ, de Vries EG (1996) Increased epithelial cell proliferation in the colon of patients with acromegaly. Cancer Res 56(3):523–526PubMed
50.
Garrouste FL, Remacle-Bonnet MM, Lehmann MM, Marvaldi JL, Pommier GJ (1997) Up-regulation of insulin/insulin-like growth factor-I hybrid receptors during differentiation of HT29-D4 human colonic carcinoma cells. Endocrinology 138(5):2021–2032PubMed
51.
Sekharam M, Zhao H, Sun M, Fang Q, Zhang Q, Yuan Z, Dan HC, Boulware D, Cheng JQ, Coppola D (2003) Insulin-like growth factor 1 receptor enhances invasion and induces resistance to apoptosis of colon cancer cells through the Akt/Bcl-x(L) pathway. Cancer Res 63(22):7708–7716PubMed
52.
Lincoln DT, Kaiser HE, Raju GP, Waters MJ (2000) Growth hormone and colorectal carcinoma: localization of receptors. Vivo 14(1):41–49
53.
Lois K, Bukowczan J, Perros P, Jones S, Gunn M, James RA (2014) The role of colonoscopic screening in acromegaly revisited: review of current literature and practice guidelines. Pituitary 18(4):568–574CrossRef
54.
Cairns SR, Scholefield JH, Steele RJ, Dunlop MG, Thomas HJ, Evans GD, Eaden JA, Rutter MD, Atkin WP, Saunders BP, Lucassen A, Jenkins P, Fairclough PD, Woodhouse CR, British Society of Gastroenterology, Association of Coloproctology for Great Britain and Ireland (2010) Guidelines for colorectal cancer screening and surveillance in moderate and high risk groups (update from 2002). Gut 59(5):666–689CrossRefPubMed
55.
Dworakowska D, Gueorguiev M, Kelly P, Monson JP, Besser GM, Chew SL, Akker SA, Drake WM, Fairclough PD, Grossman AB, Jenkins PJ (2010) Repeated colonoscopic screening of patients with acromegaly: 15-year experience identifies those at risk of new colonic neoplasia and allows for effective screening guidelines. Eur J Endocrinol 163(1):21–28CrossRefPubMed
56.
López PJT, Albero JS, Rodríguez-Montes JA (2014) Primary and secondary prevention of colorectal cancer. Clin Med Insights Gastroenterol 7:33–46
57.
dos Santos MC, Nascimento GC, Nascimento AG, Carvalho VC, Lopes MH, Montenegro R, Montenegro R Jr, Vilar L, Albano MF, Alves AR, Parente CV, dos Santos Faria M (2013) Thyroid cancer in patients with acromegaly: a case-control study. Pituitary 16(1):109–114CrossRefPubMed
58.
Rogozinski A, Furioso A, Glikman P, Junco M, Laudi R, Reyes A, Lowenstein A (2012) Thyroid nodules in acromegaly. Arq Bras Endocrinol Metabol 56(5):300–304CrossRefPubMed
59.
60.
Nanda RS (2000) The contributions of craniofacial growth to clinical orthodontics. Am J Orthod Dentofacial Orthop 117(5):553–555CrossRefPubMed
61.
Jadresic A, Banks LM, Child DF, Diamant L, Doyle FH, Fraser TR, Joplin GF (1982) The acromegaly syndrome. Relation between clinical features, growth hormone values and radiological characteristics of the pituitary tumours. Q J Med 51(202):189–204PubMed
62.
Sugata T, Myoken Y, Tanaka S (1998) Acromegaly identified in a patient with a complaint of malocclusion. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 85(1):44–46CrossRefPubMed
63.
Kropf LL, Madeira M, Neto LV, Gadelha MR, de Farias ML (2013) Functional evaluation of the joints in acromegalic patients and associated factors. Clin Rheumatol 32(7):991–998CrossRefPubMed
64.
Mazziotti G, Bianchi A, Porcelli T, Mormando M, Maffezzoni F, Cristiano A, Giampietro A, De Marinis L, Giustina A (2013) Vertebral fractures in patients with acromegaly: a 3-year prospective study. J Clin Endocrinol Metab 98(8):3402–3410CrossRefPubMed
65.
Killinger Z, Payer J, Lazurova I, Imrich R, Homerova Z, Kuzma M, Rovensky J (2010) Arthropathy in acromegaly. Rheum Dis Clin North Am 36(4):713–720CrossRefPubMed
66.
Madeira M, Neto LV, Torres CH, de Mendonca LM, Gadelha MR, de Farias ML (2013) Vertebral fracture assessment in acromegaly. J Clin Densitom 16(2):238–243CrossRefPubMed
67.
Wassenaar MJ, Biermasz NR, Hamdy NA, Zillikens MC, van Meurs JB, Rivadeneira F, Hofman A, Uitterlinden AG, Stokkel MP, Roelfsema F, Kloppenburg M, Kroon HM, Romijn JA, Pereira AM (2011) High prevalence of vertebral fractures despite normal bone mineral density in patients with long-term controlled acromegaly. Eur J Endocrinol 164(4):475–483CrossRefPubMed
68.
Scarpa R, De Brasi D, Pivonello R, Marzullo P, Manguso F, Sodano A, Oriente P, Lombardi G, Colao A (2004) Acromegalic axial arthropathy: a clinical case–control study. J Clin Endocrinol Metab 89(2):598–603CrossRefPubMed
69.
Dreval AV, Trigolosova IV, Misnikova IV, Kovalyova YA, Tishenina RS, Barsukov IA, Vinogradova AV, Wolffenbuttel BH (2014) Prevalence of diabetes mellitus in patients with acromegaly. Endocr Connect 3(2):93–98CrossRefPubMed
70.
Rosario PW (2011) Frequency of acromegaly in adults with diabetes or glucose intolerance and estimated prevalence in the general population. Pituitary 14(3):217–221CrossRefPubMed
71.
Mazziotti G, Floriani I, Bonadonna S, Torri V, Chanson P, Giustina A (2009) Effects of somatostatin analogs on glucose homeostasis: a metaanalysis of acromegaly studies. J Clin Endocrinol Metab 94(5):1500–1508CrossRefPubMed
72.
Rose DR, Clemmons DR (2002) Growth hormone receptor antagonist improves insulin resistance in acromegaly. Growth Horm IGF Res 12(6):418–424CrossRefPubMed
73.
Oscarsson J, Wiklund O, Jakobsson KE, Petruson B, Bengtsson BA (1994) Serum lipoproteins in acromegaly before and 6–15 months after transsphenoidal adenomectomy. Clin Endocrinol (Oxf) 41(5):603–608CrossRef
74.
Wiesli P, Bernays R, Brandle M, Zwimpfer C, Seiler H, Zapf J, Spinas GAS, Schmid C (2005) Effect of pituitary surgery in patients with acromegaly on adiponectin serum concentrations and alanine aminotransferase activity. Clin Chim Acta 352(1–2):175–181CrossRefPubMed
75.
76.
Sheppard M, Bronstein MD, Freda P, Serri O, De Martinis L, Naves L, Rozhinskaya L, Hermosillo Reséndiz K, Ruffin M, Chen Y, Colao A (2015) Pasireotide LAR maintains inhibition of GH and IGF-1 in patients with acromegaly for up to 25 months: results from the blinded extension phase of a randomized, double-blind, multicenter. Phase III study. Pituitary 18(3):385–394CrossRefPubMed
77.
Darzy KH (2013) Radiation-induced hypopituitarism. Curr Opin Endocrinol Diabetes Obes 20(4):342–353PubMed
78.
Carvalho P, Lau E, Carvalho D (2015) Surgery induced hypopituitarism in acromegalic patients: a systematic review and meta-analysis of the results. Pituitary 18(6):844–860CrossRefPubMed
79.
Harbeck B, Haas CS, Suefke S, Moenig H (2015) Cardiovascular risk in patients with hypothalamic-pituitary disorders. Int J Cardiol 184:464–465CrossRefPubMed
80.
Manara R, Maffei P, Citton V, Rizzati S, Bommarito G, Ermani M, Albano I, Della Puppa A, Carollo C, Pavesi G, Scanarini M, Ceccato F, Sicolo N, Mantero F, Scaroni C, Martini C (2011) Increased rate of intracranial saccular aneurysms in acromegaly: an MR angiography study and review of the literature. J Clin Endocrinol Metab 96(5):1292–1300CrossRefPubMed
81.
Manara R, Bommarito G, Rizzati S, Briani C, Della Puppa A, Citton V, Zanchetta E, Zerbo F, Ermani M, Martini C, Mantero F, Sicolo N, Maffei P, Scaroni C (2013) Herniation of cerebellar tonsils in acromegaly: prevalence, pathogenesis and clinical impact. Pituitary 16(1):122–130CrossRefPubMed
82.
Carvalho MA, Montenegro Junior RM, Freitas MR, Vilar L, Mendonca AT, Montenegro RM (2012) Sensorineural hearing loss in acromegalic patients under treatment. Braz J Otorhinolaryngol 78(4):98–102CrossRefPubMed
83.
Aydin K, Ozturk B, Turkyilmaz MD, Dagdelen S, Ozgen B, Unal F, Erbas T (2012) Functional and structural evaluation of hearing in acromegaly. Clin Endocrinol (Oxf) 76(3):415–419CrossRef
84.
Babic BB, Petakov MS, Djukic VB, Ognjanovic SI, Arsovic NA, Isailovic TV, Milovanovic JD, Macut D, Damjanovic SS (2006) Conductive hearing loss in patients with active acromegaly. Otol Neurotol 27(6):865–870CrossRefPubMed
85.
Mestron A, Webb SM, Astorga R, Benito P, Catala M, Gaztambide S, Gomez JM, Halperin I, Lucas-Morante T, Moreno B, Obiols G, de Pablos P, Paramo C, Pico A, Torres E, Varela C, Vazquez JA, Zamora J, Albareda M, Gilabert M (2004) Epidemiology, clinical characteristics, outcome, morbidity and mortality in acromegaly based on the Spanish Acromegaly Registry (Registro Espanol de Acromegalia, REA). Eur J Endocrinol 151(4):439–446CrossRefPubMed
86.
Kameyama S, Tanaka R, Hasegawa A, Tamura T, Kuroki M (1993) Subclinical carpal tunnel syndrome in acromegaly. Neurol Med Chir (Tokyo) 33(8):547–551CrossRef
87.
Giustina A, Gola M, Colao A, De Marinis L, Losa M, Sicolo N, Ghigo E (2008) The management of the patient with acromegaly and headache: a still open clinical challenge. J Endocrinol Investig 31(10):919–924CrossRef
88.
Levy MJ, Matharu M, Goadsby PJ (2008) Chronic headache and pituitary tumors. Curr Pain Headache Rep 12(1):74–78CrossRefPubMed
89.
Levy MJ (2011) The association of pituitary tumors and headache. Curr Neurol Neurosci Rep 11(2):164–170CrossRefPubMed
90.
Lancranjan I, Atkinson AB, Sandostatin LAR Group (1999) Results of a European multicentre study with Sandostatin LAR in acromegalic patients. Pituitary 1(2):105–114CrossRefPubMed
91.
Cannavo S, Squadrito S, Curto L, Almoto B, Trimarchi F (2001) Effectiveness of slow-release lanreotide in previously operated and untreated patients with GH-secreting pituitary macroadenoma. Horm Metab Res 33(10):618–624CrossRefPubMed
92.
May A, Lederbogen S, Diener HC (1994) Octreotide dependency and headache: a case report. Cephalalgia 14(4):303–304CrossRefPubMed
93.
Pereira AM, Tiemensma J, Romijn JA, Biermasz NR (2012) Cognitive impairment and psychopathology in patients with pituitary diseases. Neth J Med 70(6):255–260PubMed
94.
Pantanetti P, Sonino N, Arnaldi G, Boscaro M (2002) Self image and quality of life in acromegaly. Pituitary 5(1):17–19CrossRefPubMed
95.
Leon-Carrion J, Martin-Rodriguez JF, Madrazo-Atutxa A, Soto-Moreno A, Venegas-Moreno E, Torres-Vela E, Benito-Lopez P, Galvez MA, Tinahones FJ, Leal-Cerro A (2010) Evidence of cognitive and neurophysiological impairment in patients with untreated naive acromegaly. J Clin Endocrinol Metab 95(9):4367–4379CrossRefPubMed
96.
Sievers C, Dimopoulou C, Pfister H, Lieb R, Steffin B, Roemmler J, Schopohl J, Mueller M, Schneider HJ, Ising M, Wittchen HU, Stalla GK (2009) Prevalence of mental disorders in acromegaly: a cross-sectional study in 81 acromegalic patients. Clin Endocrinol (Oxf) 71(5):691–701CrossRef
97.
Matta MP, Couture E, Cazals L, Vezzosi D, Bennet A, Caron P (2008) Impaired quality of life of patients with acromegaly: control of GH/IGF-1 excess improves psychological subscale appearance. Eur J Endocrinol 158(3):305–310CrossRefPubMed
98.
Furman K, Ezzat S (1998) Psychological features of acromegaly. Psychother Psychosom 67(3):147–153CrossRefPubMed
Metadata
Title
Challenges in the diagnosis and management of acromegaly: a focus on comorbidities
Authors
Alin Abreu
Alejandro Pinzón Tovar
Rafael Castellanos
Alex Valenzuela
Claudia Milena Gómez Giraldo
Alejandro Castellanos Pinedo
Doly Pantoja Guerrero
Carlos Alfonso Builes Barrera
Humberto Ignacio Franco
Antônio Ribeiro-Oliveira Jr.
Lucio Vilar
Raquel S. Jallad
Felipe Gaia Duarte
Mônica Gadelha
Cesar Luiz Boguszewski
Julio Abucham
Luciana A. Naves
Nina Rosa C. Musolino
Maria Estela Justamante de Faria
Ciliana Rossato
Marcello D. Bronstein
Publication date
01-08-2016
Publisher
Springer US
Published in
Pituitary / Issue 4/2016
Print ISSN: 1386-341X
Electronic ISSN: 1573-7403
DOI
https://doi.org/10.1007/s11102-016-0725-2

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Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

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A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Pediatric Cardiology Video

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

Cardiopulmonary Comorbidity Video

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Valvular Heart Disease Video

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

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Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

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