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1. Consensus on criteria for acromegaly diagnosis and remission

Author

Giustina, Andrea, Biermasz, Nienke, Casanueva, Felipe F., Fleseriu, Maria, Mortini, Pietro, Strasburger, Christian, van der Lely, A. J., Wass, John, Melmed, Shlomo, Banfi, Giuseppe, Barkan, Ariel, Beckers, Albert, Bidlingmaier, Martin, Boguszewski, Cesar, Brue, Thierry, Buchfelder, Michael, Chanson, Philippe, Chiloiro, Sabrina, Colao, Annamaria, Coopmans, Eva, Esposito, Daniela, Ferone, Diego, Frara, Stefano, Gadelha, Mônica, Geer, Eliza B., Ghigo, Ezio, Greenman, Yona, Gurnell, Mark, Ho, Ken, Ioachimescu, Adriana, Johannsson, Gudmundur, Jørgensen, Jens Otto, Kaiser, Ursula B., Karavitaki, Niki, Katznelson, Laurence, Lamberts, Stephen, Losa, Marco, Luger, Anton, Luque, Raúl, Maffei, Pietro, Marazuela, Mónica, Neggers, Sebastian, Pereira, Alberto, Persani, Luca, Petersenn, Stephan, Reincke, Martin, Salvatori, Roberto, Samson, Susan N., Schilbach, Katharina, Shimon, Ilan, Tsagarakis, Styliano, Zatelli, Maria Chiara, Null, Null, Chiloiro, Sabrina (ORCID:0000-0001-9241-2392), Giustina, Andrea, Biermasz, Nienke, Casanueva, Felipe F., Fleseriu, Maria, Mortini, Pietro, Strasburger, Christian, van der Lely, A. J., Wass, John, Melmed, Shlomo, Banfi, Giuseppe, Barkan, Ariel, Beckers, Albert, Bidlingmaier, Martin, Boguszewski, Cesar, Brue, Thierry, Buchfelder, Michael, Chanson, Philippe, Chiloiro, Sabrina, Colao, Annamaria, Coopmans, Eva, Esposito, Daniela, Ferone, Diego, Frara, Stefano, Gadelha, Mônica, Geer, Eliza B., Ghigo, Ezio, Greenman, Yona, Gurnell, Mark, Ho, Ken, Ioachimescu, Adriana, Johannsson, Gudmundur, Jørgensen, Jens Otto, Kaiser, Ursula B., Karavitaki, Niki, Katznelson, Laurence, Lamberts, Stephen, Losa, Marco, Luger, Anton, Luque, Raúl, Maffei, Pietro, Marazuela, Mónica, Neggers, Sebastian, Pereira, Alberto, Persani, Luca, Petersenn, Stephan, Reincke, Martin, Salvatori, Roberto, Samson, Susan N., Schilbach, Katharina, Shimon, Ilan, Tsagarakis, Styliano, Zatelli, Maria Chiara, Null, Null, and Chiloiro, Sabrina (ORCID:0000-0001-9241-2392)

Abstract

Purpose The 14th Acromegaly Consensus Conference was convened to consider biochemical criteria for acromegaly diagnosis and evaluation of therapeutic efficacy.Methods Fifty-six acromegaly experts from 16 countries reviewed and discussed current evidence focused on biochemical assays; criteria for diagnosis and the role of imaging, pathology, and clinical assessments; consequences of diagnostic delay; criteria for remission and recommendations for follow up; and the value of assessment and monitoring in defining disease progression, selecting appropriate treatments, and maximizing patient outcomes.Results In a patient with typical acromegaly features, insulin-like growth factor (IGF)-I > 1.3 times the upper limit of normal for age confirms the diagnosis. Random growth hormone (GH) measured after overnight fasting may be useful for informing prognosis, but is not required for diagnosis. For patients with equivocal results, IGF-I measurements using the same validated assay can be repeated, and oral glucose tolerance testing might also be useful. Although biochemical remission is the primary assessment of treatment outcome, biochemical findings should be interpreted within the clinical context of acromegaly. Follow up assessments should consider biochemical evaluation of treatment effectiveness, imaging studies evaluating residual/recurrent adenoma mass, and clinical signs and symptoms of acromegaly, its complications, and comorbidities. Referral to a multidisciplinary pituitary center should be considered for patients with equivocal biochemical, pathology, or imaging findings at diagnosis, and for patients insufficiently responsive to standard treatment approaches.Conclusion Consensus recommendations highlight new understandings of disordered GH and IGF-I in patients with acromegaly and the importance of expert management for this rare disease.

Published
2024

2. Criteria for the definition of Pituitary Tumor Centers of Excellence (PTCOE): A Pituitary Society Statement

Author

Casanueva, Felipe F, Barkan, Ariel L., Buchfelder, Michael, Klibanski, Anne, Laws, Edward R., Loeffler, Jay S., Melmed, Shlomo, Mortini, Pietro, Wass, John, Giustina, Andrea, Lomba, Alin Abreu, Abucham, Julio, Alvarez Escola, Cristina, Barkan, Ariel L, Beckers, Albert, Ben Shlomo, Anat, Bernabeu, Ignacio, Bidlingmaier, Martin, Biermasz, Nienke, Biller, Beverly, Boguszewski, Cesar Luiz, Bolanowski, Marek, Bollerslev, Jens, Bonert, Vivien, Bronstein, Marcello, Bruno, Oscar D., Carmichael, John D., Caron, Philippe, Chanson, Philippe, Casanueva, Felipe F., Clayton, Richard N., Colao, Annamaria, Cordido, Fernando, de Marinis, Laura, Fahlbusch, Rudolf, Fleseriu, Maria, Formenti, Anna Maria, Freda, Pamela U., Fukuoka, Hidenori, Ghigo, Ezio, Greenman, Yona, Grineva, Elena, Grossman, Ashley, Gurnell, Mark, Heaney, Anthony, Hoffman, Andrew R., Ilovayskaya, Irena, Johannsson, Gudmundur, Kadioglu, Pinar, Karavitaki, Niki, Katznelson, Laurence, Kelestimur, Fahrettin, Kelly, Daniel F., Ken, Ho, Krsek, Michal, Lacroix, Andre, Stevenloeffler, Jay, Losa, Marco, Jã¸rgensen, Jens Otto, Luger, Anton, Mallea Gil, Susana, Mamelak, Adam, Mazziotti, Gherardo, Mccormack, Ann, Mercado, Moises, Neggers, Sebastian, Ning, Guang, Oyesiku, Nelson M., Popovic, Vera, Petakov, Milan, Petersenn, Stephan, Pfeifer, Misa, Pico, Antonio, Domingo, Manuel Puig, Raverot, Gã©rald, Reincke, Martin, Gadelha, Monica Roberto, Salvatori, Roberto, Samson, Susan L., Shimatsu, Akira, Shimon, Ilan, Stewart, Paul, Strasburger, Christian, Swearingen, Brooke, Trainer, Peter, Tritos, Nicholas A., Tsagarakis, Stylianos, van der Lely, A. J., Vilar, Lucio, Villar Taibo, Rocio, Zatelli, Maria Chiara, Casanueva, Felipe F., Barkan, Ariel L., Buchfelder, Michael, Klibanski, Anne, Laws, Edward R., Loeffler, Jay S., Melmed, Shlomo, Mortini, Pietro, Wass, John, Giustina, Andrea, Lomba, Alin Abreu, Abucham, Julio, Alvarez-Escola, Cristina, Barkan, Ariel L, Beckers, Albert, Ben-Shlomo, Anat, Bernabeu, Ignacio, Bidlingmaier, Martin, Biermasz, Nienke, Biller, Beverly, Boguszewski, Cesar Luiz, Bolanowski, Marek, Bollerslev, Jen, Bonert, Vivien, Bronstein, Marcello, Bruno, Oscar D., Carmichael, John D., Caron, Philippe, Chanson, Philippe, Clayton, Richard N., Colao, Annamaria, Cordido, Fernando, De Marinis, Laura, Fahlbusch, Rudolf, Fleseriu, Maria, Formenti, Anna Maria, Freda, Pamela U., Fukuoka, Hidenori, Ghigo, Ezio, Greenman, Yona, Grineva, Elena, Grossman, Ashley, Gurnell, Mark, Heaney, Anthony, Hoffman, Andrew R., Ilovayskaya, Irena, Johannsson, Gudmundur, Kadioglu, Pinar, Karavitaki, Niki, Katznelson, Laurence, Kelestimur, Fahrettin, Kelly, Daniel F., Ken, Ho, Krsek, Michal, Lacroix, Andre, Stevenloeffler, Jay, Losa, Marco, Jørgensen, Jens Otto, Luger, Anton, Mallea-Gil, Susana, Mamelak, Adam, Mazziotti, Gherardo, Mccormack, Ann, Mercado, Moise, Neggers, Sebastian, Ning, Guang, Oyesiku, Nelson M., Popovic, Vera, Petakov, Milan, Petersenn, Stephan, Pfeifer, Misa, Pico, Antonio, Domingo, Manuel Puig, Raverot, Gérald, Reincke, Martin, Gadelha, Monica Roberto, Salvatori, Roberto, Samson, Susan L., Shimatsu, Akira, Shimon, Ilan, Stewart, Paul, Strasburger, Christian, Swearingen, Brooke, Trainer, Peter, Tritos, Nicholas A., Tsagarakis, Styliano, van der Lely, A. J., Vilar, Lucio, Villar-Taibo, Rocio, Zatelli, Maria Chiara, Gurnell, Mark [0000-0001-5745-6832], Apollo - University of Cambridge Repository, and Ho, Ken

Subjects
Male, Pituitary disorder, Pituitary Diseases, Thyrotropinomas, Endocrinology, Diabetes and Metabolism, Pituitary Disease, Pituitary neoplasm, Session (web analytics), Task (project management), 0302 clinical medicine, Endocrinology, Medicine, Pituitary Neoplasm, Societies, Medical, media_common, Gonadotropin, Cushing’s disease, Cushing’s disease, 3. Good health, Diabetes and Metabolism, Treatment Outcome, Work (electrical), Pituitary Gland, Female, Cushing's disease, Human, United State, medicine.medical_specialty, media_common.quotation_subject, Thyrotropinoma, 030209 endocrinology & metabolism, NO, Pituitary radiotherapy, 03 medical and health sciences, Excellence, Medical, Acromegaly, Gonadotropins, Transsphenoidal surgery, Humans, Pituitary ACTH Hypersecretion, Pituitary Neoplasms, United States, Medical education, business.industry, Pituitary ACTH hypersecretion, Pituitary tumors, Correction, medicine.disease, Surgery, Societies, business, 030217 neurology & neurosurgery
Abstract

Introduction: With the goal of generate uniform criteria among centers dealing with pituitary tumors and to enhance patient care, the Pituitary Society decided to generate criteria for developing Pituitary Tumors Centers of Excellence (PTCOE). Methods: To develop that task, a group of ten experts served as a Task Force and through two years of iterative work an initial draft was elaborated. This draft was discussed, modified and finally approved by the Board of Directors of the Pituitary Society. Such document was presented and debated at a specific session of the Congress of the Pituitary Society, Orlando 2017, and suggestions were incorporated. Finally the document was distributed to a large group of global experts that introduced further modifications with final endorsement. Results: After five years of iterative work a document with the ideal criteria for a PTCOE is presented. Conclusions: Acknowledging that very few centers in the world, if any, likely fulfill the requirements here presented, the document may be a tool to guide improvements of care delivery to patients with pituitary disorders. All these criteria must be accommodated to the regulations and organization of Health of a given country.

Published
2017

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