Skip to main content
Top
Published in: Pituitary 1/2014

Open Access 01-01-2014

A practical approach to acromegaly management in Latin America

Authors: Marcello D. Bronstein, Oscar D. Bruno, Alin Abreu, Ruth Mangupli, Moisés Mercado

Published in: Pituitary | Special Issue 1/2014

Login to get access

Abstract

Introduction

Evidence-based treatment guidelines have undoubtedly advanced medical practice and supported optimal management of acromegaly, but their application may be hampered by limited access to the latest treatment options.

Methods

In this retrospective, narrative review, the authors revisited existing treatment guidelines for acromegaly in Latin America. These were considered in conjunction with published evidence chosen at the authors’ discretion.

Findings

In a socially and economically diverse region, such as Latin America, any regional practice guidelines need to appreciate that recommended treatment options, such as surgery by expert pituitary surgical teams and drug therapies, especially somatostatin analogs, are often not available due to limited resources. In these instances, physicians may be obliged to apply less effective therapeutic options.

Conclusions

The current article looks at the practical aspects of acromegaly management in Latin America and discusses this in the context of existing guidelines. Furthermore, we consider potential strategies to make better use of resources through combination and multimodal approaches to treatment.
Literature
1.
go back to reference de los Monteros ALE, Carrasco CA, Albarrán AAR, Gadelha M, Abreu A, Mercado M (2013) The role of primary pharmacological therapy in acromegaly. Pituitary. doi:10.1007/s11102-013-0530-0 de los Monteros ALE, Carrasco CA, Albarrán AAR, Gadelha M, Abreu A, Mercado M (2013) The role of primary pharmacological therapy in acromegaly. Pituitary. doi:10.​1007/​s11102-013-0530-0
2.
go back to reference Vilar L, Valenzuela A, Ribeiro-Oliveira A Jr, Gómez Giraldo CM, Pantoja D, Bronstein MD (2013) Multiple facets in the control of acromegaly. Pituitary. doi:10.1007/s11102-013-0536-7 Vilar L, Valenzuela A, Ribeiro-Oliveira A Jr, Gómez Giraldo CM, Pantoja D, Bronstein MD (2013) Multiple facets in the control of acromegaly. Pituitary. doi:10.​1007/​s11102-013-0536-7
5.
go back to reference Barreto SM, Miranda JJ, Figueroa JP, Schmidt MI, Munoz S, Kuri-Morales PP, Silva JB Jr (2012) Epidemiology in Latin America and the Caribbean: current situation and challenges. Int J Epidemiol 41(2):557–571PubMedCrossRef Barreto SM, Miranda JJ, Figueroa JP, Schmidt MI, Munoz S, Kuri-Morales PP, Silva JB Jr (2012) Epidemiology in Latin America and the Caribbean: current situation and challenges. Int J Epidemiol 41(2):557–571PubMedCrossRef
6.
go back to reference Pichon-Riviere A, Augustovski F, García Martí S, Sullivan SD, Drummond M (2012) Transferability of health technology assessment reports in Latin America: an exploratory survey of researchers and decision makers. Int J Technol Assess Health Care 28(2):180–186PubMedCrossRef Pichon-Riviere A, Augustovski F, García Martí S, Sullivan SD, Drummond M (2012) Transferability of health technology assessment reports in Latin America: an exploratory survey of researchers and decision makers. Int J Technol Assess Health Care 28(2):180–186PubMedCrossRef
7.
go back to reference Pichon-Riviere A, Augustovski F, Rubinstein A, Martí SG, Sullivan SD, Drummond MF (2010) Health technology assessment for resource allocation decisions: are key principles relevant for Latin America? Int J Technol Assess Health Care 26(4):421–427PubMedCrossRef Pichon-Riviere A, Augustovski F, Rubinstein A, Martí SG, Sullivan SD, Drummond MF (2010) Health technology assessment for resource allocation decisions: are key principles relevant for Latin America? Int J Technol Assess Health Care 26(4):421–427PubMedCrossRef
8.
go back to reference Acevedo K, Aguilar-Pacheco PE, Arellano Montaño S, Bastidas-Adrián MY, Domínguez B, García AR, Gómez-Martínez G, González-Estrada J, Hernández A, Hidalgo L, Jervis P, Luna-Ceballos RI, Maya-Luna M, Mercado M, Vidrio M, Padilla-Retana JA, Portocarrero L, Rangel-Sánchez G, Reza-Albarrán A, Rivera A, Trujillo-Lozoya C, Uribe AM, Velázquez FJ, Vergara A (2010) Primer reporte del registro nacional de acromegalia: Programa “Epiacro”. Revista de Endocrinología y Nutrición 18(4):176–180 Acevedo K, Aguilar-Pacheco PE, Arellano Montaño S, Bastidas-Adrián MY, Domínguez B, García AR, Gómez-Martínez G, González-Estrada J, Hernández A, Hidalgo L, Jervis P, Luna-Ceballos RI, Maya-Luna M, Mercado M, Vidrio M, Padilla-Retana JA, Portocarrero L, Rangel-Sánchez G, Reza-Albarrán A, Rivera A, Trujillo-Lozoya C, Uribe AM, Velázquez FJ, Vergara A (2010) Primer reporte del registro nacional de acromegalia: Programa “Epiacro”. Revista de Endocrinología y Nutrición 18(4):176–180
9.
go back to reference Jervis P, Trujillo C, Portocarrero L, Domínguez B, Vidrio M, Luna-Ceballos RI, Reza A, Velázquez F, Maya-Luna ML, Gómez G, Acevedo K, García R, Mercado M (2012) “Epiacro”: The Mexican Acromegaly Registry [Abstract]. Endocr Rev 33(03_MeetingAbstracts): MON-717 Jervis P, Trujillo C, Portocarrero L, Domínguez B, Vidrio M, Luna-Ceballos RI, Reza A, Velázquez F, Maya-Luna ML, Gómez G, Acevedo K, García R, Mercado M (2012) “Epiacro”: The Mexican Acromegaly Registry [Abstract]. Endocr Rev 33(03_MeetingAbstracts): MON-717
10.
go back to reference Giustina A, Barkan A, Casanueva FF, Cavagnini F, Frohman L, Ho K, Veldhuis J, Wass J, Von Werder K, Melmed S (2000) Criteria for cure of acromegaly: a consensus statement. J Clin Endocrinol Metab 85(2):526–529PubMed Giustina A, Barkan A, Casanueva FF, Cavagnini F, Frohman L, Ho K, Veldhuis J, Wass J, Von Werder K, Melmed S (2000) Criteria for cure of acromegaly: a consensus statement. J Clin Endocrinol Metab 85(2):526–529PubMed
11.
go back to reference Melmed S, Casanueva FF, Cavagnini F, Chanson P, Frohman L, Grossman A, Ho K, Kleinberg D, Lamberts S, Laws E, Lombardi G, Vance ML, Werder KV, Wass J, Giustina A (2002) Guidelines for acromegaly management. J Clin Endocrinol Metab 87:4054–4058PubMedCrossRef Melmed S, Casanueva FF, Cavagnini F, Chanson P, Frohman L, Grossman A, Ho K, Kleinberg D, Lamberts S, Laws E, Lombardi G, Vance ML, Werder KV, Wass J, Giustina A (2002) Guidelines for acromegaly management. J Clin Endocrinol Metab 87:4054–4058PubMedCrossRef
12.
go back to reference Giustina A, Casanueva FF, Cavagnini F, Chanson P, Clemmons D, Frohman LA, Gaillard R, Ho K, Jaquet P, Kleinberg DL, Lamberts SW, Lombardi G, Sheppard M, Strasburger CJ, Vance ML, Wass JA, Melmed S (2003) Pituitary society and the European neuroendocrine Association. Diagnosis and treatment of acromegaly complications. J Endocrinol Invest 26(12):1242–1247PubMed Giustina A, Casanueva FF, Cavagnini F, Chanson P, Clemmons D, Frohman LA, Gaillard R, Ho K, Jaquet P, Kleinberg DL, Lamberts SW, Lombardi G, Sheppard M, Strasburger CJ, Vance ML, Wass JA, Melmed S (2003) Pituitary society and the European neuroendocrine Association. Diagnosis and treatment of acromegaly complications. J Endocrinol Invest 26(12):1242–1247PubMed
13.
go back to reference Giustina A, Barkan A, Chanson P, Grossman A, Hoffman A, Ghigo E, Casanueva F, Colao A, Lamberts S, Sheppard M, Melmed S (2008) Guidelines for the treatment of growth hormone excess and growth hormone deficiency in adults. J Endocrinol Invest 31(9):820–838PubMed Giustina A, Barkan A, Chanson P, Grossman A, Hoffman A, Ghigo E, Casanueva F, Colao A, Lamberts S, Sheppard M, Melmed S (2008) Guidelines for the treatment of growth hormone excess and growth hormone deficiency in adults. J Endocrinol Invest 31(9):820–838PubMed
14.
go back to reference Acromegaly Consensus Group, Melmed S, Colao A, Barkan A, Molitch M, Grossman AB, Clemmons D, Chanson P, Laws E, Schlechte J, Vance ML, Ho K, Giustina A (2009) Guidelines for acromegaly management: an update. J Clin Endocrinol Metab 94(5):1509–1517PubMedCrossRef Acromegaly Consensus Group, Melmed S, Colao A, Barkan A, Molitch M, Grossman AB, Clemmons D, Chanson P, Laws E, Schlechte J, Vance ML, Ho K, Giustina A (2009) Guidelines for acromegaly management: an update. J Clin Endocrinol Metab 94(5):1509–1517PubMedCrossRef
15.
go back to reference 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):294–302PubMedCentralPubMedCrossRef 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):294–302PubMedCentralPubMedCrossRef
16.
go back to reference Barkan A, Bronstein MD, Bruno OD, Cob A, Espinosa-de-los-Monteros AL, Gadelha MR, Garavito G, Guitelman M, Mangupli R, Mercado M, Portocarrero L, Sheppard M (2010) Management of acromegaly in Latin America: expert panel recommendations. Pituitary 13(2):168–175PubMedCentralPubMedCrossRef Barkan A, Bronstein MD, Bruno OD, Cob A, Espinosa-de-los-Monteros AL, Gadelha MR, Garavito G, Guitelman M, Mangupli R, Mercado M, Portocarrero L, Sheppard M (2010) Management of acromegaly in Latin America: expert panel recommendations. Pituitary 13(2):168–175PubMedCentralPubMedCrossRef
17.
go back to reference Arellano S, Aguilar P, Domínguez B, de Los E, Monteros AL, González Virla B, Sosa E, Mercado M, Guinto G, Martínez I, Hernández E, Reza A, Portocarrero L, Vergara A, Velázquez FJ, Ramírez E (2007) Segundo Consenso Nacional de Acromegalia: recomendaciones para su diagnóstico, tratamiento y seguimiento. Revista de Endocrinología y Nutrición 15(3 Suppl 1):S7–S16 Arellano S, Aguilar P, Domínguez B, de Los E, Monteros AL, González Virla B, Sosa E, Mercado M, Guinto G, Martínez I, Hernández E, Reza A, Portocarrero L, Vergara A, Velázquez FJ, Ramírez E (2007) Segundo Consenso Nacional de Acromegalia: recomendaciones para su diagnóstico, tratamiento y seguimiento. Revista de Endocrinología y Nutrición 15(3 Suppl 1):S7–S16
18.
go back to reference Vieira Neto L, Abucham J, Araujo LA, Boguszewski CL, Bronstein MD, Czepielewski M, Jallad RS, Musolino NR, Naves LA, Ribeiro-Oliveira Júnior A, Vilar L, Faria Mdos S, Gadelha MR (2011) Recommendations of Neuroendocrinology Department from Brazilian Society of Endocrinology and Metabolism for diagnosis and treatment of acromegaly in Brazil. Arq Bras Endocrinol Metabol 55(2):91–105PubMedCrossRef Vieira Neto L, Abucham J, Araujo LA, Boguszewski CL, Bronstein MD, Czepielewski M, Jallad RS, Musolino NR, Naves LA, Ribeiro-Oliveira Júnior A, Vilar L, Faria Mdos S, Gadelha MR (2011) Recommendations of Neuroendocrinology Department from Brazilian Society of Endocrinology and Metabolism for diagnosis and treatment of acromegaly in Brazil. Arq Bras Endocrinol Metabol 55(2):91–105PubMedCrossRef
19.
go back to reference Mangupli R, Lisette A, Ivett C, Paul C, de los Ríos Victoria C, Luis CJ (2003) Improvement of acromegaly after octreotide LAR treatment. Pituitary 6(1):29–34PubMedCrossRef Mangupli R, Lisette A, Ivett C, Paul C, de los Ríos Victoria C, Luis CJ (2003) Improvement of acromegaly after octreotide LAR treatment. Pituitary 6(1):29–34PubMedCrossRef
20.
go back to reference Jallad RS, Musolino NR, Salgado LR, Bronstein MD (2005) Treatment of acromegaly with octreotide-LAR: extensive experience in a Brazilian institution. Clin Endocrinol 63(2):168–175CrossRef Jallad RS, Musolino NR, Salgado LR, Bronstein MD (2005) Treatment of acromegaly with octreotide-LAR: extensive experience in a Brazilian institution. Clin Endocrinol 63(2):168–175CrossRef
21.
go back to reference Mercado M, Borges F, Bouterfa H, Chang TC, Chervin A, Farrall AJ, Patocs A, Petersenn S, Podoba J, Safari M, Wardlaw J; SMS995B2401 Study Group (2007) A prospective, multicentre study to investigate the efficacy, safety and tolerability of octreotide LAR (long-acting repeatable octreotide) in the primary therapy of patients with acromegaly. Clin Endocrinol 66(6):859–868CrossRef Mercado M, Borges F, Bouterfa H, Chang TC, Chervin A, Farrall AJ, Patocs A, Petersenn S, Podoba J, Safari M, Wardlaw J; SMS995B2401 Study Group (2007) A prospective, multicentre study to investigate the efficacy, safety and tolerability of octreotide LAR (long-acting repeatable octreotide) in the primary therapy of patients with acromegaly. Clin Endocrinol 66(6):859–868CrossRef
22.
go back to reference Murray RD, Melmed S (2008) A critical analysis of clinically available somatostatin analog formulations for therapy of acromegaly. J Clin Endocrinol Metab 93(8):2957–2968PubMedCrossRef Murray RD, Melmed S (2008) A critical analysis of clinically available somatostatin analog formulations for therapy of acromegaly. J Clin Endocrinol Metab 93(8):2957–2968PubMedCrossRef
23.
go back to reference Sosa E, Espinosa-de-los-Monteros AL, González B, Vargas G, Mier F, Mercado M (2008) Treatment of acromegaly with octreotide LAR. Rev Med Inst Mex Seguro Soc 46(6):651–658PubMed Sosa E, Espinosa-de-los-Monteros AL, González B, Vargas G, Mier F, Mercado M (2008) Treatment of acromegaly with octreotide LAR. Rev Med Inst Mex Seguro Soc 46(6):651–658PubMed
25.
go back to reference Jallad RS, Bronstein MD (2009) Optimizing medical therapy of acromegaly: beneficial effects of cabergoline in patients uncontrolled with long-acting release octreotide. Neuroendocrinology 90(1):82–92PubMedCrossRef Jallad RS, Bronstein MD (2009) Optimizing medical therapy of acromegaly: beneficial effects of cabergoline in patients uncontrolled with long-acting release octreotide. Neuroendocrinology 90(1):82–92PubMedCrossRef
26.
go back to reference Mattar P, Alves Martins MR, Abucham J (2010) Short- and long-term efficacy of combined cabergoline and octreotide treatment in controlling IGF-I levels in acromegaly. Neuroendocrinology 92(2):120–127PubMedCrossRef Mattar P, Alves Martins MR, Abucham J (2010) Short- and long-term efficacy of combined cabergoline and octreotide treatment in controlling IGF-I levels in acromegaly. Neuroendocrinology 92(2):120–127PubMedCrossRef
27.
go back to reference Vilar L, Azevedo MF, Naves LA, Casulari LA, Albuquerque JL, Montenegro RM, Montenegro RM Jr, Figueiredo P, Nascimento GC, Faria MS (2011) Role of the addition of cabergoline to the management of acromegalic patients resistant to long-term treatment with octreotide LAR. Pituitary 14(2):148–156PubMedCrossRef Vilar L, Azevedo MF, Naves LA, Casulari LA, Albuquerque JL, Montenegro RM, Montenegro RM Jr, Figueiredo P, Nascimento GC, Faria MS (2011) Role of the addition of cabergoline to the management of acromegalic patients resistant to long-term treatment with octreotide LAR. Pituitary 14(2):148–156PubMedCrossRef
28.
go back to reference Neggers SJ, de Herder WW, Janssen JA, Feelders RA, van der Lely AJ (2009) Combined treatment for acromegaly with long-acting somatostatin analogs and pegvisomant: long-term safety for up to 4.5 years (median 2.2 years) of follow-up in 86 patients. Eur J Endocrinol 160(4):529–533PubMedCrossRef Neggers SJ, de Herder WW, Janssen JA, Feelders RA, van der Lely AJ (2009) Combined treatment for acromegaly with long-acting somatostatin analogs and pegvisomant: long-term safety for up to 4.5 years (median 2.2 years) of follow-up in 86 patients. Eur J Endocrinol 160(4):529–533PubMedCrossRef
29.
go back to reference van der Lely AJ, Bernabeu I, Cap J, Caron P, Colao A, Marek J, Neggers S, Birman P (2011) Coadministration of lanreotide Autogel and pegvisomant normalizes IGF1 levels and is well tolerated in patients with acromegaly partially controlled by somatostatin analogs alone. Eur J Endocrinol 164(3):325–333PubMedCrossRef van der Lely AJ, Bernabeu I, Cap J, Caron P, Colao A, Marek J, Neggers S, Birman P (2011) Coadministration of lanreotide Autogel and pegvisomant normalizes IGF1 levels and is well tolerated in patients with acromegaly partially controlled by somatostatin analogs alone. Eur J Endocrinol 164(3):325–333PubMedCrossRef
31.
go back to reference Jallad RS, Musolino NR, Kodaira S, Cescato VA, Bronstein MD (2007) Does partial surgical tumour removal influence the response to octreotide-LAR in acromegalic patients previously resistant to the somatostatin analogue? Clin Endocrinol 67(2):310–315CrossRef Jallad RS, Musolino NR, Kodaira S, Cescato VA, Bronstein MD (2007) Does partial surgical tumour removal influence the response to octreotide-LAR in acromegalic patients previously resistant to the somatostatin analogue? Clin Endocrinol 67(2):310–315CrossRef
32.
go back to reference Mao ZG, Zhu YH, Tang HL, Wang DY, Zhou J, He DS, Lan H, Luo BN, Wang HJ (2010) Preoperative lanreotide treatment in acromegalic patients with macroadenomas increases short-term postoperative cure rates: a prospective, randomised trial. Eur J Endocrinol 162(4):661–666PubMedCrossRef Mao ZG, Zhu YH, Tang HL, Wang DY, Zhou J, He DS, Lan H, Luo BN, Wang HJ (2010) Preoperative lanreotide treatment in acromegalic patients with macroadenomas increases short-term postoperative cure rates: a prospective, randomised trial. Eur J Endocrinol 162(4):661–666PubMedCrossRef
33.
go back to reference Abrams P, Alexopoulou O, Abs R, Maiter D, Verhelst J (2007) Optimalization and cost management of lanreotide-Autogel therapy in acromegaly. Eur J Endocrinol 157(5):571–577PubMedCrossRef Abrams P, Alexopoulou O, Abs R, Maiter D, Verhelst J (2007) Optimalization and cost management of lanreotide-Autogel therapy in acromegaly. Eur J Endocrinol 157(5):571–577PubMedCrossRef
34.
go back to reference Ramírez C, Vargas G, González B, Grossman A, Rábago J, Sosa E, Espinosa-de-Los-Monteros AL, Mercado M (2012) Discontinuation of octreotide LAR after long term, successful treatment of patients with acromegaly: is it worth trying? Eur J Endocrinol 166(1):21–26PubMedCrossRef Ramírez C, Vargas G, González B, Grossman A, Rábago J, Sosa E, Espinosa-de-Los-Monteros AL, Mercado M (2012) Discontinuation of octreotide LAR after long term, successful treatment of patients with acromegaly: is it worth trying? Eur J Endocrinol 166(1):21–26PubMedCrossRef
35.
go back to reference Jallad RS, Musolino NR, Salgado LR, Bronstein MD (2007) Treatment of acromegaly: is there still a place for radiotherapy? Pituitary 10(1):53–59PubMedCrossRef Jallad RS, Musolino NR, Salgado LR, Bronstein MD (2007) Treatment of acromegaly: is there still a place for radiotherapy? Pituitary 10(1):53–59PubMedCrossRef
36.
go back to reference González B, Vargas G, Espinosa-de-los-Monteros AL, Sosa E, Mercado M (2011) Efficacy and safety of radiotherapy in acromegaly. Arch Med Res 42(1):48–52PubMedCrossRef González B, Vargas G, Espinosa-de-los-Monteros AL, Sosa E, Mercado M (2011) Efficacy and safety of radiotherapy in acromegaly. Arch Med Res 42(1):48–52PubMedCrossRef
37.
38.
go back to reference 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 72(2):203–208CrossRef 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 72(2):203–208CrossRef
39.
go back to reference Psaras T, Milian M, Hattermann V, Freiman T, Gallwitz B, Honegger J (2011) Demographic factors and the presence of comorbidities do not promote early detection of Cushing’s disease and acromegaly. Exp Clin Endocrinol Diabetes 119(1):21–25PubMedCrossRef Psaras T, Milian M, Hattermann V, Freiman T, Gallwitz B, Honegger J (2011) Demographic factors and the presence of comorbidities do not promote early detection of Cushing’s disease and acromegaly. Exp Clin Endocrinol Diabetes 119(1):21–25PubMedCrossRef
40.
go back to reference Knutzen R, Ezzat S (2006) The cost of medical care for the acromegalic patient. Neuroendocrinology 83(3–4):139–144PubMedCrossRef Knutzen R, Ezzat S (2006) The cost of medical care for the acromegalic patient. Neuroendocrinology 83(3–4):139–144PubMedCrossRef
41.
go back to reference Rosario PW, Calsolari MR (2012) Screening for acromegaly by application of a simple questionnaire evaluating the enlargement of extremities in adult patients seen at primary health care units. Pituitary 15(2):179–183PubMedCrossRef Rosario PW, Calsolari MR (2012) Screening for acromegaly by application of a simple questionnaire evaluating the enlargement of extremities in adult patients seen at primary health care units. Pituitary 15(2):179–183PubMedCrossRef
42.
go back to reference Kasuki L, Marques NV, Nuez MJ, Leal VL, Chinen RN, Gadelha MR (2013) Acromegalic patients lost to follow-up: a pilot study. Pituitary 16(2):245–250PubMedCrossRef Kasuki L, Marques NV, Nuez MJ, Leal VL, Chinen RN, Gadelha MR (2013) Acromegalic patients lost to follow-up: a pilot study. Pituitary 16(2):245–250PubMedCrossRef
43.
go back to reference Espinosa-de-los-Monteros AL, Sosa E, Cheng S, Ochoa R, Sandoval C, Guinto G, Mendoza V, Hernández I, Molina M, Mercado M (2006) Biochemical evaluation of disease activity after pituitary surgery in acromegaly: a critical analysis of patients who spontaneously change disease status. Clin Endocrinol 64(3):245–249CrossRef Espinosa-de-los-Monteros AL, Sosa E, Cheng S, Ochoa R, Sandoval C, Guinto G, Mendoza V, Hernández I, Molina M, Mercado M (2006) Biochemical evaluation of disease activity after pituitary surgery in acromegaly: a critical analysis of patients who spontaneously change disease status. Clin Endocrinol 64(3):245–249CrossRef
44.
go back to reference McLaughlin N, Laws ER, Oyesiku NM, Katznelson L, Kelly DF (2012) Pituitary centers of excellence. Neurosurgery 71(5):916–924PubMedCrossRef McLaughlin N, Laws ER, Oyesiku NM, Katznelson L, Kelly DF (2012) Pituitary centers of excellence. Neurosurgery 71(5):916–924PubMedCrossRef
Metadata
Title
A practical approach to acromegaly management in Latin America
Authors
Marcello D. Bronstein
Oscar D. Bruno
Alin Abreu
Ruth Mangupli
Moisés Mercado
Publication date
01-01-2014
Publisher
Springer US
Published in
Pituitary / Issue Special Issue 1/2014
Print ISSN: 1386-341X
Electronic ISSN: 1573-7403
DOI
https://doi.org/10.1007/s11102-013-0531-z

Other articles of this Special Issue 1/2014

Pituitary 1/2014 Go to the issue