Acromegaly management in the Nordic countries: A Delphi consensus survey.
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Arlien-Søborg Mai C, Dal Jakob, Heck Ansgar, Stochholm Kirstine, Husted Eigil, Feltoft Claus Larsen, Rasmussen Åse Krogh, Feldt-Rasmussen Ulla, Andreassen Mikkel, Klose Marianne Christina, Nielsen Torben Leo, Andersen Marianne Skovsager, Christensen Louise Lehmann, Krogh Jesper, Jarlov Anne, Bollerslev Jens, Nermoen Ingrid, Oksnes Marianne, Dahlqvist Per, Olsson Tommy, Berinder Katarina, Hoybye Charlotte, Petersson Maria, Akerman Anna-Karin, Wahlberg Jeanette, Ekman Bertil, Engstrom Britt Eden, Johannsson Gudmundur, Ragnarsson Oskar, Olsson Daniel, Sigurjónsdóttir Helga Ágústa, Fougner Stine Lyngvi, Matikainen Niina, Vehkavaara Satu, Metso Saara, Jaatinen Pia, Hämäläinen Päivi, Rintamäki Reeta, Yliaska Iina, Immonen Heidi, Mäkimattila Sari, Cederberg-Tamminen Henna, Viukari Marianna, Nevalainen Pasi, Nuutila Pirjo, Schalin-Jäntti Camilla, Burman Pia, Jørgensen Jens Otto Lunde
Аннотация
METHODS: A Delphi process was used to map the landscape of acromegaly management in Denmark, Sweden, Norway, Finland, and Iceland. An expert panel developed 37 statements on the treatment and follow-up of patients with acromegaly. Dedicated endocrinologists (n = 47) from the Nordic countries were invited to rate their extent of agreement with the statements, using a Likert-type scale (1-7). Consensus was defined as ≥80% of panelists rating their agreement as ≥5 or ≤3 on the Likert-type scale.
RESULTS: Consensus was reached in 41% (15/37) of the statements. Panelists agreed that pituitary surgery remains first line treatment. There was general agreement to recommend first-generation somatostatin analog (SSA) treatment after failed surgery and to consider repeat surgery. In addition, there was agreement to recommend combination therapy with first-generation SSA and pegvisomant as second- or third-line treatment. In more than 50% of the statements, consensus was not achieved. Considerable disagreement existed regarding pegvisomant monotherapy, and treatment with pasireotide and dopamine agonists.
CONCLUSION: This consensus exploration study on the management of patients with acromegaly in the Nordic countries revealed a relatively large degree of disagreement among experts, which mirrors the complexity of the disease and the shortage of evidence-based data.