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Endocrine, Metabolic & Immune Disorders - Drug Targets

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ISSN (Print): 1871-5303
ISSN (Online): 2212-3873

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Position Statement

Italian Association of Clinical Endocrinologists (AME) and Italian AACE Chapter Position Statement for Clinical Practice: Acromegaly - Part 2: Therapeutic Issues

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

Volume 20, Issue 8, 2020

Page: [1144 - 1155] Pages: 12

DOI: 10.2174/1871530320666200129113328

open access plus

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.

Keywords: Acromegaly, pituitary, neurosurgery, somatostatin analogs, cabergoline, pegvisomant, pasireotide, comorbidities, discrepant, resistant, aggressive, gammaknife.

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Graphical Abstract

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