Title:Italian Association of Clinical Endocrinologists (AME) and Italian AACE Chapter Position Statement for Clinical Practice: Acromegaly - Part 2: Therapeutic Issues
VOLUME: 20 ISSUE: 8
Author(s):Renato Cozzi*, Maria R. Ambrosio, Roberto Attanasio, Alessandro Bozzao, Laura De Marinis, Ernesto De Menis, Edoardo Guastamacchia, Andrea Lania, Giovanni Lasio, Francesco Logoluso, Pietro Maffei, Maurizio Poggi, Vincenzo Toscano, Michele Zini, Philippe Chanson and Laurence Katznelson
Affiliation:Division of Endocrinology, Niguarda Hospital, Milan, Section of Endocrinology and Internal Medicine, Department of Medical Sciences, University of Ferrara, Ferrara, Endocrinology Service, IRCCS Orthopedic Institute Galeazzi, Milan, Neuroradiology, S. Andrea Hospital, NESMOS Department (Neuroscience, Mental Health, Sensorial Organs), Sapienza University of Rome, Rome, Pituitary Unit, Department of Endocrinology, Catholic University of the Sacred Heart, School of Medicine, Rome, Department of Internal Medicine, General Hospital, Montebelluna (TV), AME President, University of Bari, Bari, Department of Biomedical Sciences, IRCCS Humanitas University and Endocrinology Unit, Humanitas Research Hospital, Rozzano, Department of Neurosurgery, Humanitas University and Endocrinology Unit, Humanitas Research Hospital, Rozzano, Endocrinology Unit, Department of Emergency and Organ Transplantation, University Medical School 'Aldo Moro', Bari, Department of Medicine (DIMED), 3rd Medical Clinic, Padua University Hospital, Padua, Endocrinology, Department of Clinical and Molecular Medicine, S. Andrea Hospital, Sapienza University of Rome, Rome, Endocrinology, Department of Clinical and Molecular Medicine, S. Andrea Hospital, Sapienza University of Rome, Rome, Endocrinology Unit, Azienda Ospedaliera S. Maria Nuova IRCCS, Reggio Emilia, Endocrinology and Reproductive Diseases, Bicêtre Hospital and Paris-Saclay University 11, Department of Medicine, Stanford University Hospital, Stanford, CA
Keywords:Acromegaly, pituitary, neurosurgery, somatostatin analogs, cabergoline, pegvisomant, pasireotide, comorbidities,
discrepant, resistant, aggressive, gammaknife.
Abstract:Any newly diagnosed patient should be referred to a multidisciplinary team experienced in
the treatment of pituitary adenomas. The therapeutic management of acromegaly always requires a
personalized strategy. Normal age-matched IGF-I values are the treatment goal. Transsphenoidal surgery
by an expert neurosurgeon is the primary treatment modality for most patients, especially if there
are neurological complications. In patients with poor clinical conditions or who refuse surgery, primary
medical treatment should be offered, firstly with somatostatin analogs (SSAs). In patients who do not
reach hormonal targets with first-generation depot SSAs, a second pharmacological option with pasireotide
LAR or pegvisomant (alone or combined with SSA) should be offered. Irradiation could be
proposed to patients with surgical remnants who would like to be free from long-term medical therapies
or those with persistent disease activity or tumor growth despite surgery or medical therapy. Since
the therapeutic tools available enable therapeutic targets to be achieved in most cases, the challenge is
to focus more on the quality of life.
