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Background Acromegaly patients managed on Somatostatin receptor ligands (SRLs), the most common first-line pharmacotherapy for acromegaly, may still experience acromegaly symptoms such as headache, sweating, fatigue, soft tissue swelling, and joint pain, even those with normal IGF-1. Additionally, treatment with SRLs may cause injection site reactions and other side effects such as gastro-intestinal (GI) symptoms. This study utilized patient-reported outcome measures to examine the burden associated with acromegaly and its treatment for patients receiving a stable dose of long-acting SRLs in routine clinical practice. Methods US acromegaly patients on a stable dose of SRL seen by their treating healthcare provider in the past 12 months completed a one-time online survey including the Acro-TSQ, an acromegaly-specific tool for assessing symptom burden and treatment satisfaction and convenience. Results One hundred five patients were enrolled (mean age 49.9 years, 79.1% female). Patients experienced numerous symptoms, including > 80% who experienced joint pain, acro-fog, swelling of soft tissue, and fatigue/weakness. Many symptoms occurred constantly, while some occurred at the end of the injection cycle, even among those with IGF-1 3 acromegaly provider visits/year. Conclusions Despite receiving a stable dose of SRL and regular visits with an acromegaly healthcare provider, US acromegaly patients in routine clinical practice, and even the subgroup with normal IGF-1, report significant burden of disease and treatment.

Introduction Somatostatin analogues are used to treat symptoms and slow tumour progression in patients with neuroendocrine tumours (NETs) and carcinoid syndrome and to reduce hormone secretion and pituitary tumour volume in patients with acromegaly. A new syringe for lanreotide autogel/depot (LAN) was developed following feedback from a human factors study to improve ease of injection compared with previous syringes. PRESTO aimed to assess preferences of nurses between the LAN new syringe and the octreotide long-acting release (LAR) syringe. Methods PRESTO, a multinational, multicentre, prospective, noninterventional, simulated-use study, enrolled nurses with ≥ 2 years’ experience injecting LAN and/or octreotide LAR in patients with NETs and/or acromegaly. Nurses administered injections into pads using the LAN new syringe and octreotide LAR syringe in a randomised sequence. In an anonymous web-based questionnaire, nurses reported their overall preference (‘strong’ or ‘slight’; primary endpoint) and rated and ranked the importance of nine attributes for each syringe (1 [not at all] to 5 [very much]). Results Overall, 90 nurses attended sessions and completed valid questionnaires. Most nurses (97.8%) expressed a preference (85.6% ‘strong’, 12.2% ‘slight’) for the LAN new syringe versus the octreotide LAR syringe (P

Background Acromegaly patients, even those with IGF-1 values within the normal range receiving somatostatin receptor ligands (SRLs), often suffer from significant symptoms. It is not known to what extent patients’ medical providers are aware of the frequency and severity of acromegaly symptoms or level of treatment satisfaction with SRLs. This study sought to examine the concordance between outcomes reported by acromegaly patients treated with long-acting SRLs and those perceived by their medical provider. Methods US acromegaly patients on a stable dose of SRL and seen by their medical provider in the past year completed an online survey which included the Acro-TSQ. Their medical providers were interviewed about the perception of their patient’s symptoms, level of control, and general health, and completed relevant portions of the Acro-TSQ. Concordance between patient and medical provider reported data was examined. Results Medical providers reported that their patients experienced acromegaly symptoms on a regular basis, however, there was poor agreement between patients and medical providers on the frequency, severity, and pattern of symptoms, as well as on the severity of injection site reactions and multiple domains of the Acro-TSQ, with patients generally reporting symptoms and injection site reactions more often and with higher severity than medical providers. Conclusions Medical providers were aware that their patients who were receiving a stable dose of SRL regularly experienced acromegaly symptoms. Addressing discordance in patient- and medical provider-reported frequency and severity of acromegaly symptoms and injection site reactions by facilitating better communication may improve care of acromegaly patients.

Background: A new lanreotide autogel/depot (LAN) syringe was developed based on feedback from a human factors study to improve user experience. Methods: PRESTO was a multinational, simulated-use study in nurses with ≥2 years’ experience injecting LAN or octreotide long-acting release (OCT LAR) in patients with acromegaly and/or neuroendocrine tumors, which aimed to assess injector preference between the LAN new syringe and the current OCT LAR syringe. Participating nurses were invited to test both the LAN new syringe (120 mg) and the current OCT LAR syringe (20 mg or 30 mg), using injection pads. The sponsor was not involved in these sessions. In an anonymous web-based questionnaire, nurses reported overall preference (‘strong’ or ‘slight’; primary endpoint), and rated and ranked the importance of nine attributes for each syringe (1 [not at all] to 5 [very much]). Results: In total, 90 nurses attended injection sessions and completed valid questionnaires. Overall, 97.8% of nurses expressed a preference (85.6% ‘strong’, 12.2% ‘slight’) for LAN new syringe (p Conclusions: The PRESTO study showed that nurses preferred the user experience of the LAN new syringe over the current OCT LAR syringe across all attributes tested.

The study aimed to assess the economic burden, health-related quality of life (HRQoL), and acromegaly treatment satisfaction in the USA. A web-based, cross-sectional survey was distributed to members of Acromegaly Community. Data related to comorbidities, treatment patterns, and treatment satisfaction were collected. The costs over the past 3 months included out-of-pocket cost, sick leave, leave of absence, direct loss of job due to acromegaly, unemployment, assistance to perform household chores, and family member loss of income. The HRQoL was assessed by Acromegaly Quality of Life (AcroQoL) and EQ-5D-3L questionnaires. Among 106 patients who completed the survey (mean age: 46 years, female: 76.4%), 44.3% presented with ≥5 comorbidities, and 90.6% reporting acromegaly-related symptoms. Compared with the low-symptom group 0–3 (n=41), the 4+ symptoms group (n=65) was more likely to have depression (OR=2.3, 95% CI 1.1 to 5.2) and cardiovascular disease (OR=5.8, 95% CI 2.0 to 16.7), and experienced higher costs (loss of job: $8874 vs $1717, P=0.02; unemployment disability: $17,102 vs $429, P=0.003; household chores: $2160 vs $932, P=0.0003; family members’ income loss: $692 vs $122, P=0.03). The high-symptom group had lower HRQoL scores, compared with the low-symptom group (EQ-5D-3L: 0.53 vs 0.75, P

Introduction Although the previous lanreotide autogel/depot syringe had been well received, feedback indicated that improvements could be made to make it more user-friendly. Additionally, the view that patients should have greater involvement in the research and development process is echoed by the International Neuroendocrine Cancer Alliance. A series of studies aimed to develop and validate a new syringe that works better for patients, caregivers and healthcare professionals (HCPs) by involving these groups at key stages in the development and testing process. Methods The multicentre, international, human factor studies, consisted of four formative studies and one validation study. The formative studies collected patient, caregiver and HCP feedback on the lanreotide autogel/depot syringe on the market at the time, and on newly designed prototypes. The validation study was conducted to evaluate the final syringe to confirm that it can be used effectively and safely in the intended environment, by the intended user, for the intended purpose. Results Overall, 213 individuals participated in the studies; 145 contributed to the formative studies and 68 to the validation study. The validated new-generation syringe included several important updates compared with the lanreotide autogel/depot syringe currently on the market, including the flanges, which are now larger and have a better grip; the overcap, which is white, ridged, opaque and bigger; the plunger supports and the thermoformed tray. No participant hurt themselves or others during the validation study (although several misuses were reported), and all participants succeeded in delivering a complete dose and activating the safety system. Conclusion With collaboration, a new syringe was developed to meet the needs of patients, caregivers and HCPs, whilst ensuring lanreotide was delivered effectively and safely. These studies highlight the importance of involving patients, caregivers and HCPs in clinical evaluation studies to develop medical products that address their concerns and meet their needs. Funding Ipsen. Plain Language Summary Plain language summary available for this article. Electronic Supplementary Material The online version of this article (10.1007/s12325-019-01112-3) contains supplementary material, which is available to authorized users.

Although the previous lanreotide autogel/depot syringe had been well received, feedback indicated that improvements could be made to make it more user-friendly. Additionally, the view that patients should have greater involvement in the research and development process is echoed by the International Neuroendocrine Cancer Alliance. A series of studies aimed to develop and validate a new syringe that works better for patients, caregivers and healthcare professionals (HCPs) by involving these groups at key stages in the development and testing process. The multicentre, international, human factor studies, consisted of four formative studies and one validation study. The formative studies collected patient, caregiver and HCP feedback on the lanreotide autogel/depot syringe on the market at the time, and on newly designed prototypes. The validation study was conducted to evaluate the final syringe to confirm that it can be used effectively and safely in the intended environment, by the intended user, for the intended purpose. Overall, 213 individuals participated in the studies; 145 contributed to the formative studies and 68 to the validation study. The validated new-generation syringe included several important updates compared with the lanreotide autogel/depot syringe currently on the market, including the flanges, which are now larger and have a better grip; the overcap, which is white, ridged, opaque and bigger; the plunger supports and the thermoformed tray. No participant hurt themselves or others during the validation study (although several misuses were reported), and all participants succeeded in delivering a complete dose and activating the safety system. With collaboration, a new syringe was developed to meet the needs of patients, caregivers and HCPs, whilst ensuring lanreotide was delivered effectively and safely. These studies highlight the importance of involving patients, caregivers and HCPs in clinical evaluation studies to develop medical products that address their concerns and meet their needs. Ipsen. Plain language summary available for this article.

Lanreotide autogel/depot, a somatostatin analogue used to treat patients with acromegaly and gastroenteropancreatic neuroendocrine tumours (GEP-NETs), is currently supplied as a sterile, ready-to-use, single-dose prefilled syringe and is administered subcutaneously. To further enhance patient care, we performed several studies to i) gain insights into patient, caregiver and healthcare professional (HCP) use of the current delivery system (DS) and ii) evaluate use of a new improved DS developed from this patient-centred approach. From June 2015 to September 2016, 4 formative studies were conducted in Europe and the US in participants representing patients with acromegaly (n=33) or GEP-NETs (n=21), caregivers (n=3), nurses (n=73), and other relevant HCPs (n=2). These studies provided feedback on the current DS; identified challenges/areas for improvement; evaluated a prototype new DS; and identified critical tasks. A human factor (HF) validation study was then performed in the US and Germany (May/June 2017) to determine whether the new DS could be used safely and effectively in its intended setting. Inclusion criteria included: patients with acromegaly, or non-diagnosed participants with enlarged hands and fingers/dexterity issues and willingness to self-inject (acromegaly representatives); a caregiver of/patient with a GEP-NET, or non-diagnosed participants willing to inject self/someone else (GEP-NET representatives/caregivers). Critical tasks were assessed by asking participants to perform two injections with the new DS into their chosen site on a mannequin. Results of the HF validation study are reported. Formative study-led improvements to the new DS included: ergonomics (larger flanges to improve handling; robust over-cap to improve needle shield removal); robustness of injection process (plunger support); intuitiveness of use (tray to protect the DS and prevent accidental plunger depression; recessed areas to improve handling); needle exposure (white opaque over-cap, improved retractable needle system after injection). The HF validation study comprised US participants (N=35) (including HCPs who did [n=16] or did not [n=19] receive training prior to testing) and German participants (N=33) (including acromegaly representatives [n=15] and GEP-NET representatives/caregivers [n=18]; all received training before testing). Among HCPs, 13 task errors were noted in untrained participants and 3 in trained participants. Among German participants, 18 task errors were noted in acromegaly representatives and 16 in GEP-NET representatives/caregivers. No task errors were specific to the new DS. A new delivery system for lanreotide depot/autogel was developed in conjunction with patients, caregivers and HCPs. It is hoped that the ergonomic, robust and intuitive delivery system will further improve patient care. Sponsored by Ipsen

Aim To understand how endocrinology health care professionals’ (HCP) perceive their acromegaly patients (pts) treatment outcomes Methods We undertook a two-staged study in which US acromegaly pts on a stable dose of SSAs for the past year completed an online survey. Their treating HCP was interviewed to provide their perception of the individual pt that completed the survey focusing on biochemical control; symptom (sx) control and interference; adverse reactions; general health; and sx interference, treatment satisfaction, bother, and convenience from the Acro-TSQ. (One HCP was a DNP; all others were endocrinologists.) The HCP was requested to have the medical records for that individual pt available during the interview, and completed the questions based on his/her perception of the pt’s outcomes. Preliminary data from the subset of 30 HCPs treating pts that were well-controlled biochemically (IGF-1≤1xULN) of the 39 interviewed were analyzed descriptively. Analyses of concordance between pts and HCPs are reported elsewhere. Results 39 HCPs (mean time in practice = 20 + 12 yrs; 64% in academic setting) were enrolled. Of those, a subset of 30 HCPs (77%) treated pts that were well controlled biochemically. These 30 HCPs reported that pts experienced moderate or severe acromegaly-related sxs, despite being biochemically controlled and receiving a stable dose of SSA. Specifically, HCPs reported that the majority of their pts experienced fatigue/weakness/feeling tired (87%), joint pain (70%), headaches (60%) and soft tissue swelling (43%). Forgetfulness/short-term memory loss/feeling in a daze, referred to as “acro-fog,” was reported by 33% of HCPs. Quite often, the HCP was not able to describe the temporal pattern (constant or at different periods throughout the injection interval) for their pts’ sxs. HCPs reported that only 27% of their pts were symptomatically well controlled. Mean HCPs’ ratings of pts’ general health, on a 0 to 100 scale with 0 = worst and 100 = best health imaginable was 73 + 17 (range = 25-95). When HCPs were asked to provide input on what treatment aspect their pt would like to improve, 50% stated that pts wanted better symptom control. The mean domain score for sx interference with daily life from the Acro-TSQ was 57 + 27, with 0 = most and 100 = least interference. Conclusions This is the first study to assess HCP perceptions of their individual patient’s outcomes. HCPs were aware of the significant sx burden and impact in general health and daily life experienced by their biochemically-controlled pts. The fact that treatment was kept stable, despite having active acromegaly sxs, suggests an unmet need in this population. Unless otherwise noted, all abstracts presented at ENDO are embargoed until the date and time of presentation. For oral presentations, the abstracts are embargoed until the session begins. Abstracts presented at a news conference are embargoed until the date and time of the news conference. The Endocrine Society reserves the right to lift the embargo on specific abstracts that are selected for promotion prior to or during ENDO.

Aim To understand concordance between outcomes reported by US acromegaly patients (pts) treated with long-acting somatostatin analogues (SSA) and those perceived by their treating endocrinology health care professional (HCP). Methods US acromegaly pts receiving a stable dose of SSA for the past year completed an online survey focusing on disease characteristics; routine management; symptoms (sxs); adverse reactions; general health; and sx interference, treatment satisfaction, bother, and convenience from the Acro-TSQ. Their HCPs were interviewed to understand differences in perspective between pts and providers. Concordance data from the first 30 pt-HCP pairs were analyzed using Cohen’s kappa for nominal data (e.g., present/absent), Cohen’s weighted kappa for ordinal data (e.g., mild/moderate/severe), and intraclass correlation coefficients (ICCs) for continuous data (e.g., ratings from 0-100). Kappa values of 0.90 excellent reliability. Results 30 pts (80% female; mean age 47 + 12 yrs; mean time since diagnosis = 10 + 8 yrs; 77% biochemically well controlled (per HCP ratings); mean IGF-1 = 0.86xULN; 37% on octreotide; 63% lanreotide; 63% on SSA monotherapy) and their HCP (mean practice time = 20 +13 yrs; 63% in academic setting) were enrolled. Pts and HCPs agreed that pts experience numerous acromegaly-related sxs. Concordance for ratings of general sx control was moderate (kappa = .51). Concordance on specific sx severity ratings was poor (kappa range: -0.26 - -0.01) for headaches, joint pain, soft tissue swelling, carpal tunnel syndrome, vision problems, and snoring, or slight (range: 0.14 - 0.16) for fatigue/weakness/feeling tired, excessive sweating and “acro-fog.” Pts rated their sxs more severe than HCPs. Pts and HCPs agreed that some sxs were constant (>40%). Pts reported that up to 33% of sxs occurred at the end of the injection cycle vs. up to 13% for HCPs. Many HCPs were unsure of the temporal pattern. Agreement on Acro-TSQ items varied (e.g., moderate-to-good agreement for sx interference with daily activities, but poor agreement on GI side effect interference with daily activities). Pts and HCPs agreed that injection-related signs and sxs were common. However, concordance on severity ratings was poor (range: -0.007 - 0.003), with pts’ ratings more severe than HCPs. Conclusions Pts and HCPs agreed that, despite being fairly well-controlled biochemically and receiving stable dosing of injectable SSAs, pts experience acromegaly-related sxs. There was a lack of agreement for severity, temporal pattern, and effect on daily life, with pts typically reporting greater severity than their HCP. These findings highlight a significant unmet need in the treatment of acromegaly pts. Unless otherwise noted, all abstracts presented at ENDO are embargoed until the date and time of presentation. For oral presentations, the abstracts are embargoed until the session begins. Abstracts presented at a news conference are embargoed until the date and time of the news conference. The Endocrine Society reserves the right to lift the embargo on specific abstracts that are selected for promotion prior to or during ENDO.

Aims This study seeks to understand patient-reported outcomes by describing the disease burden for US acromegaly patients (pts) treated with long-acting somatostatin analogues (SSA). Methods We undertook a two-staged study in which US acromegaly pts treated within the past year, receiving a stable dose of SSA, completed an online survey focusing on disease characteristics, routine management, symptoms (sxs), adverse drug reactions, treatment satisfaction and general health (Stage 1). Their treating physicians were interviewed (Stage 2) to understand differences in perspective between pts and providers. Preliminary data from Stage 1 were analyzed descriptively. Results 65 pts (75% F; mean(sd) age = 49(12) yrs; mean time since dx = 10(8) yrs; 40% on octreotide; 60% lanreotide; 68% on SSA monotherapy) were enrolled. SSA injections were received either at home (54%) or doctor’s office (46%). 15% of pts self-injected. Most pts (86%) saw their doctor within the last 6 mos. The mean number of doctor visits over the past yr was 3.3(2.5), range: 1-13. 69% of pts reported adequate biochemical control, but only 31% reported adequate symptomatic control. Despite being on stable doses of SSA, pts report headaches (78%), fatigue/weakness (80%), excessive sweating (69%), joint pain (85%), soft tissues swelling (83%), carpal tunnel symptoms (63%), vision problems (54%), snoring (66%), forgetfulness, and short-term memory loss or feeling in a daze (referred to as “acro-fog”) (86%). Most sxs were experienced constantly; however, >20% of pts experienced headaches, excessive sweating, joint pain, and soft tissue swelling at the end of the injection cycle. Pts reported moderate or severe pain at the injection site during the injection (41%), several hours post-injection (40%), and several days post-injection (38%). Pts reported moderate or severe bruising and swelling (33%), moderate or severe nodules (53%) and moderate or severe scar tissue/hardness (53%) at the injection site. 66% of pts experienced GI side effects (66%), lasting on average 11(11) days post injection (range 2-42). Pts were bothered by the amount of time they experienced sxs (100%), by injection site reactions (74%), the need to schedule injections (60%), and travel to receive injections (71%). Mean overall rating of general health on a 0 to 100 scale was 62(19), range: 23-92. However, only 14% of pts were very satisfied, 23% were satisfied, and 26% were somewhat satisfied with their current treatment overall. Conclusions These preliminary findings highlight the importance of collecting patient-reported data. Despite being on a stable dose of an injectable SSA, seeing their physician regularly and reporting adequate biochemical control, US acromegaly pts in routine clinical practice report significant burden of disease including inadequate symptom control and treatment dissatisfaction.

Acromegaly is a rare disorder characterized by overproduction of growth hormone (GH) predominantly by a pituitary adenoma. Clinical features associated with acromegaly are a result of chronic excess GH and insulin-like growth factor-I (IGF-1) effects on tissue, bone, and other organs.

Cushing’s syndrome is a rare disorder characterized by prolonged exposure to excessive concentrations of glucocorticoids. Endogenous Cushing’s syndrome, which will be the focus of this chapter, is usually divided into adrenocorticotropic hormone (ACTH)-dependent and ACTH-independent causes. ACTH-dependent Cushing’s syndrome accounts for approximately 80–85% of all cases and is primarily due to excess ACTH production from a pituitary adenoma. This is also called Cushing’s disease. In Cushing’s disease, pituitary adrenocorticotropic hormone (ACTH) oversecretion (from corticotrophs) prompts bilateral adrenocortical hyperplasia, excess production of cortisol, adrenal androgens, and 11-deoxycorticosterone which together cause the clinical and biological features of this disease. The most common clinical features of Cushing’s syndrome include central obesity, diabetes, hypertension, moon facies, facial plethora, proximal muscle weakness, and reddish purple striae and in children, impaired growth with concomitant weight gain.

Acromegaly, caused by growth hormone overproduction, is associated with comorbidities causing significant clinical dysfunction and high mortality risk. Outcomes are hampered by late diagnosis and poor treatment tolerance and adherence. The goal of this paper is to present a scoping review of the benefits and characterize potential burdens of current treatments that may limit achieving disease control or treatment continuity. Current treatments include transsphenoidal surgery, often followed by the use of synthetic somatostatin analogues or growth hormone receptor antagonists. Radiotherapy is considered an adjunct to treatment for nonresponsive patients or recurrent tumors. Despite therapeutic benefits the burdens to the patient equate to an estimated one quarter of patients discontinuing treatment or that are lost to follow up with up to 88% of these cases having uncontrolled disease. Although disease outcomes are improved with early disease identification and prompt treatment, attention to long term treatment adherence is critical to outcomes. The most cost effective and efficacious strategies involve a significant understanding of the individual patient’s disease and treatment burdens, the patient’s knowledge regarding their disease and the full utilization of all health care team resources. Provider awareness of factors impacting follow-up, the application of precision medicine and implementation of a team approach that actively involves the patients, nurses, and physicians in treatment decisions, location convenient disease monitoring with coordination of treatment for co-morbidities and home drug administration are key factors in facilitating long term treatment adherence.

Background Somatostatin analogs (SSAs) are a mainstay therapy for the treatment of carcinoid syndrome associated with neuroendocrine tumors (NETs). They are effective for a range of gastroenteropancreatic NETs (GEP-NETs). Lanreotide depot (Somatuline®) is an SSA that is approved for the treatment of GEP-NETs to improve progression-free survival (PFS). Objectives The article reviews the efficacy, safety, and administration of lanreotide depot and relates those attributes to considerations and preferences of oncology nurses and their patients. Methods A review of the literature on the use of lanreotide for the treatment of NETs and carcinoid syndrome was conducted. In addition, the literature on drug delivery and routes of administration was surveyed to provide context for comparative studies related to clinical and patient preferences. Findings Lanreotide depot prolongs PFS and is well tolerated by patients who expressed satisfaction in the ability to control symptoms related to carcinoid syndrome. Nurses cited several benefits to using lanreotide depot in the clinical setting, including more time saved to address other patient care issues. Attributes of lanreotide depot-including its efficacy, safety and tolerability, dosing and administration, and cost-may contribute to healthcare decisions regarding the treatment and management of NETs.

Daphne T Adelman,1 Andrea Burgess,2 Philippa R Davies,31Feinberg School of Medicine, Northwestern University, Chicago, IL, USA; 2Neuroendocrine Tumor Department, The Christie, Manchester, UK; 3Neuroendocrine Tumor Unit, Royal Free Hospital, London, UKAbstract: The somatostatin analogs (SSAs) lanreotide Autogel/Depot and octreotide long-acting release are used to treat acromegaly and neuroendocrine tumors. The present study evaluated opinions on SSA injection devices, including a recently approved lanreotide new device (lanreotide-ND), among nurses in Europe and the USA. Nurses injecting SSAs for at least three patients per year (n = 77) were interviewed regarding SSA devices. Device attributes were rated via questionnaire; nurses were then timed administering test injections with lanreotide-ND and octreotide long-acting release. The most important delivery system attributes were easy/convenient preparation and injection (ranked in the top five by 70% of nurses), low clogging risk (58%), and high product efficacy (55%). Compared with the octreotide long-acting release device, lanreotide-ND scored higher on 15/16 attributes, had shorter mean preparation and administration time (329 versus 66 seconds, respectively; P ≤ 0.01) and a higher overall preference score (70 versus 114, respectively; P ≤ 0.01). The five most important lanreotide-ND attributes were: prefilled device, confidence a full dose was delivered, low clogging risk, easy/convenient preparation and injection, and fast administration. These device features could lead to improvements in clinical practice and benefit patients/caregivers who administer SSAs at home.Keywords: nurse, somatostatin analog, device, lanreotide, octreotide

The Endocrine Tumor Summit convened in December 2008 to address 6 statements prepared by panel members that reflect important questions in the treatment of acromegaly and carcinoid syndrome. Data pertinent to each of the statements were identified through review of pertinent literature by one of the 9-member panel, enabling a critical evaluation of the statements and the evidence supporting or refuting them. Three statements addressed the validity of serum growth hormone (GH) and insulin-like growth factor-I (IGF-I) concentrations as indicators or predictors of disease in acromegaly. Statements regarding the effects of preoperative somatostatin analog use on pituitary surgical outcomes, their effects on hormone and symptom control in carcinoid syndrome, and the efficacy of extended dosing intervals were reviewed. Panel opinions, based on the level of available scientific evidence, were polled. Finally, their views were compared with those of surveyed community-based endocrinologists and neurosurgeons.

Acromegaly is a rare disease most often caused by the prolonged secretion of excess growth hormone from a pituitary adenoma. The disease is associated with multiple significant comorbidities and increased mortality. The delay to diagnosis is often long. This may be because of low disease awareness among health care professionals, the insidious onset of differentiating features, and because patients are likely to present with complaints typical of other conditions more frequently seen in primary care. Early identification of acromegaly facilitates prompt treatment initiation and may minimize the permanent effects of excess growth hormone. The primary treatment for many patients will be pituitary surgery, although not all patients will be eligible for surgery or achieve a surgical cure. If biochemical control is not achieved following surgery, other treatment options include medical therapy and radiation therapy. Improved biochemical control may only alleviate rather than reverse the associated comorbidities. Thus, lifelong monitoring of patient health is needed, with particular attention to the management of cardiovascular risk factors. It is additionally important to consider the impact of both disease and treatment on patients' quality of life and minimize that impact where possible, but particularly for chronic therapies. For the majority of patients, chronic therapy is likely to include somatostatin analog injections. In some circumstances, it may be possible to extend the dosing interval of the analog once good biochemical control is achieved. Additional convenience may be gained from the possibility of self-/partner administration of treatment or administration of treatment by a health care professional at home. Overall, it is clear that the care of patients with acromegaly requires a highly coordinated approach involving numerous specialties (eg, endocrinology, surgery, cardiology). Further, patients' needs must be at the core of management and every effort must be made to improve health care experiences and minimize treatment burdens.