Daily life reflections of acromegaly guidelines

J Endocrinol Invest. 2017 Mar;40(3):323-330. doi: 10.1007/s40618-016-0567-9. Epub 2016 Oct 20.

Abstract

Purpose: To determine the differences in acromegaly diagnosis, treatment, and follow-up among Turkish endocrinologists, and to investigate how the published guidelines are applied in clinical practice.

Methods: The questionnaire was formatted as an electronic survey, conducted between November and December 2015, and sent weekly for 6 weeks via e-mail to 528 endocrinologists in Turkey.

Results: The questionnaire was answered by 37.4 % of endocrinologists. Insulin-like growth factor-1 and nadir growth hormone level after 75 g oral glucose tolerance test (nadir GH-OGTT) were the most commonly preferred methods for the initial diagnosis. A total of 49.5 % of the participants reported using preoperative medical therapy (MT) either routinely or on a case-to-case basis. Somatostatin analogs were the most commonly used drugs, both in pre- and postoperative MT. Disease activity following surgery was assessed in the 3rd postoperative month using IGF-1 levels. Similarly, IGF-1 monitoring was preferred in the follow-up period. Monitoring nadir GH-OGTT levels was the most commonly used method in the assessment of discordant test results. The dose titration was done at month 3 after the start of MT. Resistance to SRLs was considered after using the maximal dose for at least 6 months. Pegvisomant was generally used in second- and third-line therapy. Similarly, cabergoline was not preferred in monotherapy by the majority of participants. Radiotherapy was considered in patients with incomplete response to surgery and medical treatments.

Conclusions: Although there were subtle differences, clinical practice guidelines were usually followed among Turkish endocrinologists.

Keywords: Acromegaly; Daily life practice; Growth hormone; Insulin-like growth factor 1; Questionnaire.

MeSH terms

  • Acromegaly / diagnosis
  • Acromegaly / therapy*
  • Activities of Daily Living*
  • Endocrinology*
  • Humans
  • Practice Guidelines as Topic / standards*
  • Practice Patterns, Physicians' / standards*