The 13th Acromegaly Consensus Conference was held in November 2019 in Fort Lauderdale, Florida, and comprised acromegaly experts including endocrinologists and neurosurgeons who considered optimal approaches for multidisciplinary acromegaly management. Focused discussions reviewed techniques, results, and side effects of surgery, radiotherapy, and medical therapy, and how advances in technology and novel techniques have changed the way these modalities are used alone or in combination. Effects of treatment on patient outcomes were considered, along with strategies for optimizing and personalizing therapeutic approaches. Expert consensus recommendations emphasize how best to implement available treatment options as part of a multidisciplinary approach at Pituitary Tumor Centers of Excellence.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
Colao A, Grasso LFS, Giustina A, Melmed S, Chanson P, Pereira AM, et al. Acromegaly. Nat Rev Dis Primers. 2019;5:20.
Giustina A. Acromegaly and vertebral fractures: facts and questions. Trends Endocrinol Metab. 2020 Apr;31(4):274–5. https://doi.org/10.1016/j.tem.2020.01.011 Epub 2020 Feb 1.
Giustina A, Boni E, Romanelli G, Grassi V, Giustina G. Cardiopulmonary performance during exercise in acromegaly, and the effects of acute suppression of growth hormone hypersecretion with octreotide. Am J Cardiol. 1995;75(15):1042–7. https://doi.org/10.1016/s0002-9149(99)80721-8.
Giustina A, Barkan A, Beckers A, Biermasz N, Biller BMK, Boguszewski C, Bolanowski M, Bonert V, Bronstein MD, Casanueva FF, Clemmons D, Colao A, Ferone D, Fleseriu M, Frara S, Gadelha MR, Ghigo E, Gurnell M, Heaney AP, Ho K, Ioachimescu A, Katznelson L, Kelestimur F, Kopchick J, Krsek M, Lamberts S, Losa M, Luger A, Maffei P, Marazuela M, Mazziotti G, Mercado M, Mortini P, Neggers S, Pereira AM, Petersenn S, Puig-Domingo M, Salvatori R, Shimon I, Strasburger C, Tsagarakis S, van der Lely AJ, Wass J, Zatelli MC, Melmed S. A consensus on the diagnosis and treatment of acromegaly comorbidities: an update.J Clin Endocrinol Metab. 2020 Apr 1;105(4). pii: dgz096. doi: https://doi.org/10.1210/clinem/dgz096.
Gadelha MR, Kasuki L, Lim DST, Fleseriu M. Systemic complications of acromegaly and the impact of the current treatment landscape: an update. Endocr Rev. 2019;40(1):268–332. https://doi.org/10.1210/er.2018-00115.
Petrossians P, Daly AF, Natchev E, Maione L, Blijdorp K, Sahnoun-Fathallah M, et al. Acromegaly at diagnosis in 3173 patients from the Liège acromegaly survey (LAS) database. Endocr Relat Cancer. 2017;24(10):505–18. https://doi.org/10.1530/ERC-17-.
Melmed S. Pituitary-Tumor Endocrinopathies. N Engl J Med. 2020;382(10):937–50.
Melmed S, Bronstein MD. Chanson P, et al a consensus statement on acromegaly therapeutic outcomes. Nat Rev Endocrinol. 2018;14:552–61.
Melmed S, Colao A, Barkan A, Molitch M, Grossman AB, Kleinberg D, et al. Guidelines for acromegaly management: an update. J Clin Endocrinol Metab. 2009;94(5):1509–17. https://doi.org/10.1210/jc.2008-2421.
Casanueva FF, Barkan AL. Buchfelder M, et al; pituitary society, expert group on pituitary tumors. Criteria for the definition of pituitary tumor centers of excellence (PTCOE): a pituitary society statement. Pituitary. 2017;20:489–98.
Guyatt G, Oxman AD, Akl EA, Kunz R, Vist G, Brozek J, et al. GRADE guidelines: 1. Introduction-GRADE evidence profiles and summary of findings tables. J Clin Epidemiol. 2011;64(4):383–94. https://doi.org/10.1016/j.jclinepi.2010.04.026.
Melmed S, Casanueva FF, Klibanski A, Bronstein MD, Chanson P, Lamberts SW, et al. A consensus on the diagnosis and treatment of acromegaly complications. Pituitary. 2013;16(3):294–302. https://doi.org/10.1007/s11102-012-0420-x.
Giustina A, Barkan A, Casanueva FF, Cavagnini F, Frohman L, Ho K, et al. Criteria for cure of acromegaly: a consensus statement. J Clin Endocrinol Metab. 2000;85(2):526–9. https://doi.org/10.1210/jcem.85.2.6363.
Giustina A, Chanson P, Bronstein MD, Klibanski A, Lamberts S, Casanueva FF, et al. A consensus on criteria for cure of acromegaly. J Clin Endocrinol Metab. 2010;95(7):3141–8. https://doi.org/10.1210/jc.2009-2670.
Schilbach K, Gar C, Lechner A, Nicolay SS, Schwerdt L, Haenelt M, et al. Determinants of the growth hormone nadir during oral glucose tolerance test in adults. Eur J Endocrinol. 2019;181(1):55–67. https://doi.org/10.1530/EJE-19-0139.
Carmichael JD, Bonert VS, Mirocha JM, Melmed S. The utility of oral glucose tolerance testing for diagnosis and assessment of treatment outcomes in 166 patients with acromegaly. J Clin Endocrinol Metab. 2009;94(2):523–7. https://doi.org/10.1210/jc.2008-1371.
Giustina A, Mazziotti G, Fontanella M. Commentary: postsurgical monitoring of acromegaly. Neurosurgery. 2013;73(4):E746–8. https://doi.org/10.1227/NEU.0000000000000068.
Clemmons DR. IGF-I assays: current assay methodologies and their limitations. Pituitary. 2007;10(2):121–8. https://doi.org/10.1007/s11102-007-0032-z.
Feelders RA, Bidlingmaier M, Strasburger CJ, Janssen JAMJL, Uitterlinden P, Hofland LJ, et al. Postoperative evaluation of patients with acromegaly: clinical significance and timing of oral glucose tolerance testing and measurement of (free) insulin-like growth factor I, acid-labile subunit, and growth hormone-binding protein levels. J Clin Endocrinol Metab. 2005;90(12):6480–9. https://doi.org/10.1210/jc.2005-0901.
Cunha MLVD, Borba LAB, Boguszewski CL. Random GH and IGF-I levels after transsphenoidal surgery for acromegaly: relation with long-term remission. Endocrine. 2020;68(1):182–91. https://doi.org/10.1007/s12020-020-02227-2.
Espinosa-de-los-Monteros AL, Gonzalez B, Vargas G, Sosa E, Mercado M. Octreotide, treatment of acromegaly in “real life”: long-term outcome at a tertiary care center. Pituitary. 2015;18(3):290–6. https://doi.org/10.1007/s11102-014-0570-0.
Bianchi A, Giustina A, Cimino V, Pola R, Angelini F, Pontecorvi A, et al. Influence of growth hormone receptor d3 and full-length isoforms on biochemical treatment outcomes in acromegaly. J Clin Endocrinol Metab. 2009;94(6):2015–22. https://doi.org/10.1210/jc.2008-1337.
Schilbach K, Strasburger CJ, Bidlingmaier M. Biochemical investigations in diagnosis and follow up of acromegaly. Pituitary. 2017;20(1):33–45. https://doi.org/10.1007/s11102-017-0792-z.
Amato G, Mazziotti G, Rotondi M, Iorio S, Doga M, Sorvillo F, et al. Long-term effects of lanreotide SR and octreotide LAR on tumour shrinkage and GH hypersecretion in patients with previously untreated acromegaly. Clin Endocrinol. 2002;56(1):65–71. https://doi.org/10.1046/j.0300-0664.2001.01438.x.
Dogansen SC, Yalin GY, Tanrikulu S, Tekin S, Nizam N, Bilgic B, et al. Clinicopathological significance of baseline T2-weighted signal intensity in functional pituitary adenomas. Pituitary. 2018;21:347–54.
Puig-Domingo M, Resmini E, Gomez-Anson B, Nicolau J, Mora M, Palomera E, et al. Magnetic resonance imaging as a predictor of response to somatostatin analogs in acromegaly after surgical failure. J Clin Endocrinol Metab. 2010;95(11):4973–8. https://doi.org/10.1210/jc.2010-0573.
Potorac I, Beckers A, Bonneville JF. T2-weighted MRI signal intensity as a predictor of hormonal and tumoral responses to somatostatin receptor ligands in acromegaly: a perspective. Pituitary. 2017;20(1):116–20. https://doi.org/10.1007/s11102-017-0788-8.
González B, Vargas G, de Los Monteros ALE, Mendoza V, Mercado M. Persistence of diabetes and hypertension after multimodal treatment of acromegaly. J Clin Endocrinol Metab. 2018;103(6):2369–75. https://doi.org/10.1210/jc.2018-00325.
Giustina A, Bronstein MD, Chanson P, Petersenn S, Casanueva FF, Sert C, et al. Staging and managing patients with acromegaly in clinical practice: baseline data from the SAGIT validation study. Pituitary. 2019;22:476–87.
van der Lely AJ, Gomez R, Pleil A, Badia X, Brue T, Buchfelder M, et al. Development of ACRODAT®, a new software medical device to assess disease activity in patients with acromegaly. Pituitary. 2017;20(6):692–701. https://doi.org/10.1007/s11102-017-0835-5.
Fleseriu M, Fogelfeld L, Gordon MB, Sisco J, Colwell HH, Ludlam WH, et al. Development of a novel patient-reported measure for acromegaly: the Acro-TSQ. Pituitary. 2019;22:581–93.
Jackson Y, Flood E, Rhoten S, Janssen EM, Lundie M. AcroVoice: eliciting the patients’ perspective on acromegaly disease activity. Pituitary. 2019;22:62–9.
Biermasz NR. The burden of disease for pituitary patients. Best Pract Res Clin Endocrinol Metab. 2019;33:101309.
Honegger J, Grimm F. The experience with transsphenoidal surgery and its importance to outcomes. Pituitary. 2018;21:545–55.
Buchfelder M, Schlaffer SM, Zhao Y. The optimal surgical techniques for pituitary tumors. Best Pract Res Clin Endocrinol Metab. 2019;33:101299.
Amano K, Aihara Y, Tsuzuki S, Okada Y, Kawamata T. Application of indocyanine green flourescence endoscopic system in transsphenoidal surgery for pituitary tumors. Acta Neurochir. 2019;161:695–706.
Sandow N, Klene W, Elbelt U, Strasburger CJ, Vajkoczy P. Intraoperative indocyanine green videoangiography for identification of pituitary adenomas using a microscopic transsphenoidal approach. Pituitary. 2015;18(5):613–20. https://doi.org/10.1007/s11102-014-0620-7.
Rutkowski M, Zada G. Management of pituitary adenomas invading the cavernous sinus. Neurosurg Clin N Am. 2019;30:445–55.
Antunes X, Ventura N, Camilo GB, Wildemberg LE, Guasti A, Pereira PJM, et al. Predictors of surgical outcome and early criteria of remission in acromegaly. Endocrine. 2018;60(3):415–22. https://doi.org/10.1007/s12020-018-1590-8.
Micko AS, Wöhrer A, Wolfsberger S, Knosp E. Invasion of the cavernous sinus space in pituitary adenomas: endoscopic verification and its correlation with an MRI-based classification. J Neurosurg. 2015;122(4):803–11. https://doi.org/10.3171/2014.12.JNS141083.
Jane JA Jr, Starke RM, Elzoghby MA, Reames DL, Payne SC, Thorner MO, et al. Endoscopic transsphenoidal surgery for acromegaly: remission using modern criteria, complications, and predictors of outcome. J Clin Endocrinol Metab. 2011;96:2732–40.
Agrawal N, Ioachimescu AG. Prognostic factors of biochemical remission after transsphenoidal surgery for acromegaly: a structured review [published online ahead of print, 2020 Jun 29]. Pituitary. 2020. https://doi.org/10.1007/s11102-020-01063-x.
Mortini P, Barzaghi LR, Albano L, Panni P, Losa M. Microsurgical therapy of pituitary adenomas. Endocrine. 2018;59:72–81.
Buttan A, Mamelak AN. Endocrine outcomes after pituitary surgery. Neurosurg Clin N Am. 2019;30:491–8.
Fahlbusch R, Kleinberg D, Biller B, Bonert V, Buchfelder M, Cappabianca P, et al. Surgical debulking of pituitary adenomas improves responsiveness to octreotide LAR in the treatment of acromegaly. Pituitary. 2017;20:668–75.
Mortini P, Nocera G, Roncelli F, Losa M, Formenti AM, Giustina A. The optimal numerosity of the referral population of pituitary tumors centers of excellence (PTCOE): A surgical perspective [published online ahead of print, 2020 Jun 2]. Rev Endocr Metab Disord. 2020;https://doi.org/10.1007/s11154-020-09564-7. doi:https://doi.org/10.1007/s11154-020-09564
Albarel F, Castinetti F, Morange I, Guibert N, Graillon T, Dufour H, et al. Pre-surgical medical treatment, a major prognostic factor for long-term remission in acromegaly. Pituitary. 2018;21:615–23.
Polat Korkmaz O, Gurcan M, Nuhoglu Kantarci FE, Haliloglu O, Ozkaya HM, Sahin S, et al. The effects of pre-operative somatostatin analogue therapy on treatment cost and remission in acromegaly. Pituitary. 2019;22:387–96.
Nunes VS, Correa JM, Puga ME, Silva EM, Boguszewski CL. Preoperative somatostatin analogues versus direct transsphenoidal surgery for newly-diagnosed acromegaly patients: a systematic review and meta-analysis using the GRADE system Pituitary 2015;18(4):500–8.
Lv L, Hu Y, Zhou P, Zhang S, Yin S, Zhang N, et al. Presurgical treatment with somatostatin analogues in growth-hormone-secreting pituitary adenomas: a long-term single-center experience. Clin Neurol Neurosurg. 2018;167:24–30.
Losa M, Bollerslev J. Pros and cons in endocrine practice: pre-surgical treatment with somatostatin analogues in acromegaly. Endocrine. 2016;52:451–7.
Almeida JP, Ruiz-Treviño AS, Liang B, Omay SB, Shetty SR, Chen YN, et al. Reoperation for growth-hormone secreting pituitary adenomas: endonasal endoscopic series and systematic review of the literature. J Neurosurg. 2018;129:404–16.
de los Monteros AL E, González B, Vargas G, Sosa E, Guinto G, Mercado M. Surgical reintervention in acromegaly: is it still worth trying? Endocr Pract. 2009;15:431–7.
Chen CJ, Ironside N, Pomeraniec IJ, Chivukula S, Buell TJ, Ding D, et al. Microsurgical versus endoscopic transsphenoidal resection for acromegaly: a systematic review of outcomes and complications. Acta Neurochir. 2017 Nov;159(11):2193–207. https://doi.org/10.1007/s00701-017-3318-6.
Conger A, Zhao F, Wang X, Eisenberg A, Griffiths C, Esposito F, et al. Evolution of the graded repair of CSF leaks and skull base defects in endonasal endoscopic tumor surgery: trends in repair failure and meningitis rates in 509 patients. J Neurosurg. 2018;130(3):861–75. https://doi.org/10.3171/2017.11.JNS172141.
Perry A, Graffeo CS, Meyer J, Carlstrom LP, Oushy S, Driscoll CLW, et al. Beyond the learning curve: comparison of microscopic and endoscopic incidences of internal carotid injury in a series of highly experienced operators. World Neurosurg. 2019;131:e128–35.
Pagliano P, Caggiano C, Ascione T, Solari D, di Flumeri G, Cavallo LM, et al. Characteristics of meningitis following transsphenoidal endoscopic surgery: a case series and a systematic literature review. Infection. 2017;45(6):841–8. https://doi.org/10.1007/s15010-017-1056-6.
Bohl MA, Ahmad S, Jahnke H. Delayed hyponatremia is the most common cause of 30-day unplanned readmission after transsphenoidal surgery for pituitary tumors. Neurosurgery. 2016 Jan;78(1):84–90.
Winograd D, Staggers KA, Sebastian S, Takashima M, Yoshor D, Samson SL. An effective and practical fluid restriction protocol to decrease the risk of hyponatremia and readmissions after transsphenoidal surgery [published online ahead of print, 2020 Jan 28]. Neurosurgery. 2020;nyz555. doi:https://doi.org/10.1093/neuros/nyz555
Ding D, Mehta GU, Patibandla MR, Lee CC, Liscak R, Kano H, et al. Stereotactic radiosurgery for acromegaly: an international multicenter retrospective cohort study. Neurosurgery. 2019;84:717–25.
Gheorghiu ML. Updates in outcomes of stereotactic radiation therapy in acromegaly. Pituitary. 2017;20:154–68.
Gonzalez-Virla B, Vargas-Ortega G, Martínez-Vázquez KB, et al. Efficacy and safety of fractionated conformal radiation therapy in acromegaly: a long-term follow-up study. Endocrine. 2019;65:386–92.
Sala E, Moore JM, Amorin A, Martinez H Jr, Bhowmik AC, Lamsam L, et al. CyberKnife robotic radiosurgery in the multimodal management of acromegaly patients with invasive macroadenoma: a single center's experience. J Neuro-Oncol. 2018;138:291–8.
Weidlich GA, Bodduluri M, Achkire Y, Lee C, Adler JR Jr. Characterization of a novel 3 megavolt linear accelerator for dedicated intracranial stereotactic radiosurgery. Cureus. 2019;11(3):e4275.
Kong DS, Kim YH, Kim YH, Hur KY, Kim JH, Kim MS, et al. Long-term efficacy and tolerability of gamma knife radiosurgery for growth hormone-secreting adenoma: a retrospective multicenter study (MERGE-001). World Neurosurg. 2019;122:e1291–9.
Minniti G, Jaffrain-Rea ML, Osti M, Esposito V, Santoro A, Solda F, et al. The long-term efficacy of conventional radiotherapy in patients with GH-secreting pituitary adenomas. Clin Endocrinol. 2005;62(2):210–6. https://doi.org/10.1111/j.1365-2265.2005.02199.x.
Cordeiro D, Xu Z, Li CE, et al. Hypopituitarism after gamma knife radiosurgery for pituitary adenomas: a multicenter international study. J Neurosurg. 2018;131:1188–96.
Giustina A, Bronstein MD, Casanueva FF, Chanson P, Ghigo E, Ho KKY, et al. Current management practices for acromegaly: an international survey. Pituitary. 2011;14(2):125–33. https://doi.org/10.1007/s11102-010-0269-9.
Frara S, Maffezzoni F, Mazziotti G, Giustina A. The modern criteria for medical management of acromegaly. Prog Mol Biol Transl Sci. 2016;138:63–83. https://doi.org/10.1016/bs.pmbts.2015.10.015.
Alqurani H, Del Pilar SM, Mirakhur B, Barkan A. Biochemical efficacy of long-acting lanreotide depot/autogel in patients with acromegaly naive to somatostatin-receptor ligands: analysis of three multicenter clinical trials. Pituitary. 2018;21:283–9.
Lamberts SW, Hofland L. ANNIVERSARY REVIEW: Octreotide, 40 years later. Eur J Endocrinol 2019;181:R173-R183.
Colao A, Auriemma RS, Pivonello R, Kasuki L, Gadelha MR. Interpreting biochemical control response rates with first-generation somatostatin analogues in acromegaly. Pituitary. 2016;19(3):235–47. https://doi.org/10.1007/s11102-015-0684-z.).
Giustina A, Mazziotti G, Torri V, Spinello M, Floriani I, Melmed S. Meta-analysis on the effects of octreotide on tumor mass in acromegaly. PLoS One. 2012;7(5):e36411. https://doi.org/10.1371/journal.pone.0036411.
Mazziotti G, Giustina A. Effects of lanreotide SR and autogel on tumor mass in patients with acromegaly: a systematic review. Pituitary. 2010;13(1):60–7. https://doi.org/10.1007/s11102-009-0169-z.
Coopmans EC, Korevaar TIM, van Meyel SWF, et al. Multivariable prediction model for biochemical response to first-generation somatostatin receptor ligands in acromegaly. J Clin Endocrinol Metab. 2020 Jun 26;dgaa387. doi: 10.1210/clinem/dgaa387.
Caron PJ, Bevan JS, Petersenn S, Flanagan D, Tabarin A, Prévost G, et al. Tumor shrinkage with lanreotide autogel 120 mg as primary therapy in acromegaly: results of a prospective multicenter clinical trial. J Clin Endocrinol Metab. 2014;99(4):1282–90. https://doi.org/10.1210/jc.2013-3318.
Petersenn S, Houchard A, Sert C, Caron PJ, PRIMARYS Study Group. Predictive factors for responses to primary medical treatment with lanreotide autogel 120 mg in acromegaly: post hoc analyses from the PRIMARYS study. Pituitary. 2020;23(2):171–81. https://doi.org/10.1007/s11102-019-01020-3.
Giustina A, Bonadonna S, Bugari G, Colao A, Cozzi R, Cannavo S, et al. High-dose intramuscular octreotide in patients with acromegaly inadequately controlled on conventional somatostatin analogue therapy: a randomised controlled trial. Eur J Endocrinol. 2009;161(2):331–8. https://doi.org/10.1530/EJE-09-0372.
Giustina A, Mazziotti G, Cannavò S, Castello R, Arnaldi G, Bugari G, et al. High-dose and high-frequency lanreotide autogel in acromegaly: a randomized, multicenter study. J Clin Endocrinol Metab. 2017;102(7):2454–64. https://doi.org/10.1210/jc.2017-00142.
Samson SL, Nachtigall LB, Fleseriu M, Gordon MB, Bolanowski M, Labadzhyan A, et al. Maintenance of acromegaly control in patients switching from injectable somatostatin receptor ligands to oral octreotide therapy. J Clin Endocrinol Metab. 2020. https://doi.org/10.1210/clinem/dgaa526.
Colao A, Bronstein MD, Freda P, Gu F, Shen CC, Gadelha M, et al. Pasireotide versus octreotide in acromegaly: a head-to-head superiority study. J Clin Endocrinol Metab. 2014;99(3):791–9. https://doi.org/10.1210/jc.2013-2480.
Gadelha MR, Bronstein MD, Brue T, Coculescu M, Fleseriu M, Guitelman M, et al. Pasireotide versus continued treatment with octreotide or lanreotide in patients with inadequately controlled acromegaly (PAOLA): a randomised, phase 3 trial. Lancet Diabetes Endocrinol. 2014;2(11):875–84. https://doi.org/10.1016/S2213-8587(14)70169-X.
Colao A, Bronstein MD, Brue T, de Marinis L, Fleseriu M, Guitelman M, et al. Pasireotide for acromegaly: long-term outcomes from an extension to the phase III PAOLA study. Eur J Endocrinol. 2020;182(6):583. https://doi.org/10.1530/EJE-19-0762.
Mazziotti G, Floriani I, Bonadonna S, Torri V, Chanson P, Giustina A. Effects of somatostatin analogs on glucose homeostasis: a metaanalysis of acromegaly studies. J Clin Endocrinol Metab. 2009;94(5):1500–8. https://doi.org/10.1210/jc.2008-2332.
Schmid HA, Brue T, Colao A, Gadelha MR, Shimon I, Kapur K, et al. Effect of pasireotide on glucose- and growth hormone-related biomarkers in patients with inadequately controlled acromegaly. Endocrine. 2016;53(1):210–9. https://doi.org/10.1007/s12020-016-0895-8.
Samson S, Gu F, Feldt-Rasmussen U, et al. A multicenter, randomized, open-label, phase IV study investigating management of pasireotide-associated hyperglycemia with incretin-based therapy or insulin in patients with acromegaly or Cushing’s disease. J Endocr Soc. 2019;3(suppl 1):Abstract MON-LB079.
Howlett TA, Willis D, Walker G, et al. Control of growth hormone and IGF1 in patients with acromegaly in the UK: responses to medical treatment with somatostatin analogues and dopamine agonists. Clin Endocrinol (Oxf) 2013;79(5): 689–99.Clin Endocrinol 2018;88(6):889–95.
Sandret L, Maison P, Chanson P. Place of cabergoline in acromegaly: a metaanalysis. J Clin Endocrinol Metab. 2011;96(5):1327–35.
Suda K, Inoshita N, Iguchi G, Fukuoka H, Takahashi M, Nishizawa H, et al. Efficacy of combined octreotide and cabergoline treatment in patients with acromegaly: a retrospective clinical study and review of the literature. Endocr J. 2013;60(4):507–15.
Bernabeu I, Alvarez-Escola C, Paniagua AE, et al. Pegvisomant and cabergoline combination therapy in acromegaly. Pituitary. 2013;16(1):101–8.
Giustina A, Arnaldi G, Bogazzi F, Cannavò S, Colao A, de Marinis L, de Menis E, Degli Uberti E, Giorgino F, Grottoli S, Lania AG, Maffei P, Pivonello R, Ghigo E Pegvisomant in acromegaly: an update [published correction appears in J Endocrinol Invest. 2017 Dec 28;:]. J Endocrinol Investig 2017;40(6):577–589. doi:https://doi.org/10.1007/s40618-017-0614-1.
van der Lely AJ, Kuhn E, Muhammad A, Coopmans EC, Neggers SJ, Chanson P. Pegvisomant and not somatostatin receptor ligands (SRLs) is first-line medical therapy for acromegaly. Eur J Endocrinol. 2020;182(6):D17–29. https://doi.org/10.1530/EJE-19-0998.
Trainer PJ, Drake WM, Katznelson L, Freda PU, Herman-Bonert V, van der Lely AJ, et al. Treatment of acromegaly with the growth hormone-receptor antagonist pegvisomant. N Engl J Med. 2000;342(16):1171–7. https://doi.org/10.1056/NEJM200004203421604.
van der Lely AJ, Hutson RK, Trainer PJ, Besser GM, Barkan AL, Katznelson L, et al. Long-term treatment of acromegaly with pegvisomant, a growth hormone receptor antagonist. Lancet. 2001;358(9295):1754–9. https://doi.org/10.1016/s0140-6736(01)06844-1.
Basavilbaso NXG, Ballarino MC, Bruera D, Bruno OD, Chervin AB, Danilowicz K, et al. Pegvisomant in acromegaly: a multicenter real-life study in Argentina. Arch Endocrinol Metab. 2019;63:320–7.
Boguszewski CL, Huayllas MKP, Vilar L, Naves LA, Ribeiro-Oliveira Junior A, Soares BS, et al. Brazilian multicenter study on pegvisomant treatment in acromegaly. Arch Endocrinol Metab. 2019;63:328–36.
Buchfelder M, van der Lely AJ, Biller BMK, Webb SM, Brue T, Strasburger CJ, et al. Long-term treatment with pegvisomant: observations from 2090 acromegaly patients in ACROSTUDY. Eur J Endocrinol. 2018;179(6):419–27. https://doi.org/10.1530/EJE-18-0616.
Giustina A. Optimal use of pegvisomant in acromegaly: are we getting there? Endocrine. 2015;48(1):3–8. https://doi.org/10.1007/s12020-014-0462-0.
Franck SE, Korevaar TIM, Petrossians P, Daly AF, Chanson P, Jaffrain-Réa ML, et al. A multivariable prediction model for pegvisomant dosing: monotherapy and in combination with long-acting somatostatin analogues. Eur J Endocrinol. 2017;176(4):421–31. https://doi.org/10.1530/EJE-16-0956.
van der Lely AJ, Jönsson P, Wilton P, Åkerblad AC, Cara J, Ghigo E. Treatment with high doses of pegvisomant in 56 patients with acromegaly: experience from ACROSTUDY. Eur J Endocrinol. 2016;175(4):239–45. https://doi.org/10.1530/EJE-16-0008.
Chiloiro S, Giampietro A, Frara S, et al. Effects of pegvisomant and pasireotide LAR on vertebral fractures in acromegaly resistant to first-generation SRLs. J Clin Endocrinol Metab. 2020;105(3):dgz054. doi:https://doi.org/10.1210/clinem/dgz054
Brue T, Lindberg A, van der Lely A, et al. Diabetes in patients with acromegaly treated with pegvisomant: observations from ACROSTUDY. Endocrine. 2019;63:563–72.
Feola T, Cozzolino A, Simonelli I, Sbardella E, Pozza C, Giannetta E, et al. Pegvisomant improves glucose metabolism in acromegaly: a meta-analysis of prospective interventional studies. J Clin Endocrinol Metab. 2019;104:2892–902.
Strasburger CJ, Mattson A, Wilton P, Aydin F, Hey-Hadavi J, Biller BMK. Increasing frequency of combination medical therapy in the treatment of acromegaly with the GH receptor antagonist pegvisomant. Eur J Endocrinol. 2018;178:321–9.
Leonart LP, Tonin FS, Ferreira VL, Fernandez-Llimos F, Pontarolo R. Effectiveness and safety of pegvisomant: a systematic review and meta-analysis of observational longitudinal studies. Endocrine. 2019;63:18–26.
Muhammad A, van der Lely AJ, Delhanty PJD, Dallenga AHG, Haitsma IK, Janssen JAMJL, et al. Efficacy and safety of switching to pasireotide in patients with acromegaly controlled with pegvisomant and first-generation somatostatin analogues (PAPE study). J Clin Endocrinol Metab. 2018;103(2):586–95. https://doi.org/10.1210/jc.2017-02017.
Chiloiro S, Bima C, Tartaglione T, Giampietro A, Gessi M, Lauretti L, et al. Pasireotide and pegvisomant combination treatment in acromegaly resistant to second line therapies: a longitudinal study. J Clin Endocrinol Metab. 2019;104:5478–82.
Ho KKY, Fleseriu M, Wass J, van der Lely A, Barkan A, Giustina A, et al. A tale of pituitary adenomas: to NET or not to NET: pituitary society position statement. Pituitary. 2019;22:569–73.
Whitelaw BC. How and when to use temozolomide to treat aggressive pituitary tumours. Endocr Relat Cancer. 2019;26(9):R545–52. https://doi.org/10.1530/ERC-19-0083.
Frara S, Rodriguez-Carnero G, Formenti AM, Martinez-Olmos MA, Giustina A, Casanueva FF. Pituitary Tumors Centers of Excellence. Endocrinol Metab Clin North Am. 2020;49(3):553–564. https://doi.org/10.1016/j.ecl.2020.05.010
The 13th Acromegaly Consensus Conference was supported by unrestricted educational grants from Ipsen and Pfizer Inc. Scientific sponsorship of the meeting was provided by Cedars-Sinai Medical Center, Los Angeles, CA.
No original data from studies on patients are reported in this manuscript and therefore no ethical approval or informed consent was needed.
Conflicts of interest/competing interests
AG is consultant for Chiasma, Genevant, Ipsen, Pfizer and Recordati and received research grants from Ipsen, Novartis and Pfizer to his Institution.
AB has received research funding from Pfizer and travel and speaker grants from Novartis and Ipsen.
BMKB is PI of research support to Massachsuetts General Hospital from Crinetics, Ionis and Novartis, occasional consulting honoraria from Chiasma, Crinetics and Novartis.
CLB has served as consultant/speaker for Novartis and Ipsen.
MB has served as speaker for Novartis, Ipsen, Pfizer and Recordati.
VB has received research grants from Pfizer, and has served on advisory boards for Pfizer.
MDB is Member of Steering Committees and Advisory Boards of Chiasma, Ipsen, Novartis; Speaker for Ipsen, Novartis; and has received grants as PI for clinical trials from Crinetics, Ipsen, and Novartis.
PC has received unrestricted research and educational grants from Ipsen, Novartis, Crinetics and Pfizer on behalf of the Service of Endocrinology and Reproductive Diseases, Hôpitaux Universitaires Paris-Saclay and Association Recherche Endocrinologie Bicêtre, and has served as investigator (principal or coordinator) for clinical trials funded by Novartis, Pfizer, Ipsen, Italpharmaco, Chiasma. PC gave lectures for Ipsen, Novartis, and Pfizer. All the fees and honoraria are paid to his Institution or Research Association.
DC served as an advisory board member for Crinetics.
MF has received research support to OHSU as principal investigator from Chiasma, Crinetics, Ionis, Novartis and has received occasional scientific consulting from Chiasma, Crinetics, Ionis, Novartis, Pfizer.
PUF has received research grant to her institution for clinical research studies from Pfizer, Novartis, Ipsen and Chiasma.
MRG has been principal investigator in clinical trials from Novartis and Crinectics, has served on advisory boards for Novartis and Crinectics and served as apeaker for Novatis and Ipsen.
EBG is an investigator for research grants to MSKCC from Ionis, Novartis, Corcept, Strongbridge Biopharma, and Bristol-Myers Squibb. She has received a speaker’s fee for an educational presentaion for Chiasma.
APH has served as consultant/ speaker for Ipsen and Chiasma.
AGI has received institution-directed research grants from Chiasma, Strongbridge and Novartis and served as consultant for Tiburio.
PM received consultation or speaker fee, support for congress participation, and contribution to research projects from by Pfizer, Novartis, and Ipsen.
MEM received research support from Chiasma, Novartis, Ionis, and Crinetics.
SP has served as an advisory board member for Ipsen, Novartis, and Crinetics, and as speaker for Ipsen, Novartis, and Pfizer.
MPD has recived research grants from Pfizer and Novartis, has served on advisory boards for Pfizer, Novartis and Ipsen, and served as speaker for Novartis, Ipsen and Pfizer.
RS received support for educational activities at Johns Hopkins University from Pfizer and support clinical trials from Chiasma, Crinetics and Novartis.
SLS has served as an advisor and/or investigator for Novartis, Chiasma, Pfizer, and Ipsen, and has received investigator-initiated funding from Novartis.
IS has served as consultant and speaker for Novartis, Pfizer and Medison Pharma.
CS served as an advisor to and received speaker’s fees from Pfizer, Ipsen, Chiasma and Crinetics.
PT serves on advisory boards for Novartis, Crinetics, Chiasma and has received research funding to support clinical trials from Novartis, Crinetics, Chiasma, Strongbridge, Camarus. All honoraria and reseach income is administered by his institution.
MEW has received research grants to her institution for clinical research studies from Ionis and reviewed investigator-initiated research proposals for Pfizer.
KCJY has received research grants to his institution for clinical research studies from Ionis, Crinetics, and Novartis, and has served on advisory boards for Pfizer, and Ipsen.
MCZ received consulting fees from Novartis and Ipsen.
SM has received consulting fees from Chiasma, Crinetics, Ionis, Ipsen and research grants to the institution from Pfizer.
GB, ABS, NB, JB, MB, FC, AMF, MG, KKYH, SL, EL, ML, AM, MM, PM, MP, KP, BS, MLV, and JW have no conflict of interests to declare.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Giustina, A., Barkhoudarian, G., Beckers, A. et al. Multidisciplinary management of acromegaly: A consensus. Rev Endocr Metab Disord 21, 667–678 (2020). https://doi.org/10.1007/s11154-020-09588-z
- Multidisciplinary management
- Medical therapy
- Pituitary tumor centers of excellence