Position statement on the diagnosis and management of acromegaly: The French National Diagnosis and Treatment Protocol (NDTP)

被引：7

作者：

Brue, Thierry ^{[1
,2
,21
]}

Rahabi, Haifa ^{[1
]}

Barry, Abdoulaye ^{[1
]}

Barlier, Anne ^{[1
,2
]}

Bertherat, Jerome ^{[3
]}

Borson-Chazot, Francoise ^{[4
]}

Castinetti, Frederic ^{[1
,2
]}

Cazabat, Laure ^{[3
,5
]}

Chabre, Olivier ^{[6
]}

Chevalier, Nicolas ^{[7
]}

Christin-Maitre, Sophie ^{[8
]}

Cortet, Christine ^{[9
]}

Drui, Delphine ^{[10
]}

Kamenicky, Peter ^{[11
]}

Lancon, Catherine ^{[12
]}

Liote, Frederic ^{[13
]}

Pellegrini, Isabelle

Reynaud, Rachel ^{[14
]}

Salenave, Sylvie ^{[11
]}

Tauverono, Igor ^{[15
]}

Tourainep, Philippe ^{[16
]}

Vantyghem, Marie-Christine

Verges, Bruno ^{[2
,17
]}

Vezzosi, Delphine ^{[18
]}

Villas, Chiara ^{[19
]}

Raverotd, Gerald

Coutantt, Regis ^{[20
]}

Chansonk, Philippe ^{[11
]}

Albarela, Frederique ^{[1
]}

机构：

[1] Hop Conception, AP HM, Ctr Reference Malad Rares Hypophyse HYPO, Serv Endocrinol, 147 Blvd Baille, F-13005 Marseille, France

[2] Aix Marseille Univ, INSERM, MMG, Marseille Med Genet, Marseille, France

[3] AP HP Ctr Univ Paris C, Ctr Univ Paris Cite, AP HP, Serv Endocrinol, Paris, France

[4] Hosp Civils Lyon, Ctr Reference Malad Rares Hypophyse HYPO Groupemen, Reference Ctr Inherited Metab Disorders, 59 Blvd Pinel, F-69677 Bron, France

[5] Hop Foch, Serv Neurochirurg, UMR 1198 BREED, UFR Simone Veil Sante,UVSQ Paris Saclay, 40 Rue Worth, F-92150 Suresnes, France

[6] Univ Grenoble Alpes, UMR 1292 Inserm CEA UGA, Endocrinol, CHU Grenoble Alpes, F-38000 Grenoble, France

[7] Univ Cote Azur, Equipe 5, CHU, Inserm U1065,C3M, Nice, France

[8] Sorbonne Univ, Hop St Antoine, AP HP, Ctr Reference Malad Endocriniennes Rares Croissanc, 184 Rue Faubourg St Antoine, F-75012 Paris, France

[9] Serv endocrinol diabetol & Malad Metab, Serv Endocrinol Diabetol & Malad Metab, CHRU Lille, Rue Polonowski, Lille, France

[10] Ctr Hosp Univ Nantes, Ctr hospitalier Univ Nantes, Serv Endocrinol, Blvd Jacques Monod, F-44093 Nantes, France

[11] Univ Paris Saclay, Hop BicetreLe Kremlin Bicetre, AP HP, Inserm,Ctr Reference Malad Rares Hypophyse,Serv En, Paris, France

[12] Assoc Natl Acromegalie Reconnue Interet Gen, Acromegales Pas Seulement, F-59234 Villers Au Tertre, France

[13] Univ Paris Cite, Hop Lariboisiere, AP HP, F-75475 Paris 10, France

[14] Hop Timone enfants, AP HM, Ctr Reference Malad Rares Hypophyse HYPO, Serv Pediat Multidisciplinaire, F-13005 Marseille, France

[15] Univ Clermont Auvergne, Inst Genet Reprod & Dev iGReD, Serv Endocrinol Diabetol, CHU Clermont Ferrand,CNRS,Inserm, Clermont Ferrand, France

[16] Sorbonne Univ Med, Hop Pitie Salpetriere, Ctr Malad Endocrinennes Rares Croissance & Dev, Serv Endocrinol & Med Reprod, Paris, France

[17] Ctr Inserm LNC UMR1231, Serv Endocrinol, CHU Dijon, 14 Rue Gaffarel, F-21000 Dijon, France

[18] Univ Paul Sabatier, Hop Larrey, Serv Endocrinol, CHU Toulouse, 24 Chemin Pouvourville,TSA 30030, F-21059 Toulouse 9, France

[19] Sorbonne Univ, Hop Pitie Salpetriere, AP HP, AP, 47-83 Blvd Hop, F-75651 Paris 13, France

[20] Univ Angers, Ctr Reference Malad Rares Hypophyse, Serv Endocrinol Diabetol Nutr, CHU Angers, Angers, France

[21] Concept Hosp, Dept Endocrinol, 147 Blvd Baille, F-13005 Marseille, France

来源：

ANNALES D ENDOCRINOLOGIE | 2023年 / 84卷 / 06期

关键词：

Acromegaly; Consensus; Guidelines; Recommendations; Guidance; Position statement; Pituitary surgery; Somatostatin analogues; Pasireotide; Cabergoline; Pegvisomant; Growth hormone; Somatotroph adenoma; Pituitary neuroendocrine tumor; Acromegalic arthropathy; Treatment; Diagnosis and care protocol; CLINICAL-PRACTICE GUIDELINES; AGGRESSIVE PITUITARY-TUMORS; LONG-TERM EFFICACY; GROWTH-HORMONE; SLEEP-APNEA; SOMATOSTATIN ANALOGS; ECTOPIC SECRETION; MEDICAL-TREATMENT; EUROPEAN-SOCIETY; AIP MUTATIONS;

D O I：

10.1016/j.ando.2023.08.003

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Acromegaly is a rare disease with prevalence of approximately 60 cases per million, slight female predominance and peak onset in adults in the fourth decade. Clinical diagnosis is often delayed by several years due to the slowly progressive onset of symptoms. There are multiple clinical criteria that define acromegaly: dysmorphic syndrome of insidious onset, symptoms related to the pituitary tumor (headaches, visual disorders), general signs (sweating, carpal tunnel syndrome, joint pain, etc.), complications of the disease (musculoskeletal, cardiovascular, pneumological, dental, metabolic comorbidities, thyroid nodules, colonic polyps, etc.) or sometimes clinical signs of associated prolactin hypersecretion (erectile dysfunction in men or cycle disorder in women) or concomitant mass-induced hypopituitarism (fatigue and other symptoms related to pituitary hormone deficiencies). Biological confirmation is based initially on elevated IGF-I and lack of GH suppression on oral glucose tolerance test or an elevated mean GH on repeated measurements. In confirmed cases, imaging by pituitary MRI identifies the causal tumor, to best determine management. In a minority of cases, acromegaly can be linked to a genetic predispo-sition, especially when it occurs at a young age or in a familial context. The first-line treatment is most often surgical removal of the somatotroph pituitary tumor, either immediately or after transient medical treatment. Medical treatments are most often proposed in patients not controlled by surgical removal. Conformal or stereotactic radiotherapy may be discussed on a case-by-case basis, especially in case of drug inefficacy or poor tolerance. Acromegaly should be managed by a multidisciplinary team, preferably within an expert center such as a reference or skill center for rare pituitary diseases. (c) 2023 Published by Elsevier Masson SAS.

引用

页码：697 / 710

页数：14

共 147 条

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