Mai C. Arlien-Søborg, Jakob Dal, Ansgar Heck, Kirstine Stochholm, Eigil Husted, Claus Larsen Feltoft, Åse Krogh Rasmussen, Ulla Feldt-Rasmussen, Mikkel Andreassen, Marianne Christina Klose, Torben Leo Nielsen, Marianne Skovsager Andersen, Louise Lehmann Christensen, Jesper Krogh, Anne Jarlov, Jens Bollerslev, Ingrid Nermoen, Marianne Oksnes, Per Dahlqvist, Tommy Olsson, Katarina Berinder, Charlotte Hoybye, Maria Petersson, Anna-karin Akerman, Jeanette Wahlberg, Bertil Ekman, Britt Eden Engstrom, Gudmundur Johannsson, Oskar Ragnarsson, Daniel Olsson, Helga Ágústa Sigurjónsdóttir, Stine Lyngvi Fougner, Niina Matikainen, Satu Vehkavaara, Saara Metso, Pia Jaatinen, Päivi Hämäläinen, Reeta Rintamäki, Iina Yliaska, Heidi Immonen, Sari Mäkimattila, Henna Cederberg-Tamminen, Marianna Viukari, Pasi Nevalainen, Pirjo Nuutila, Camilla Schalin-Jäntti, Pia Burman, Jens Otto Lunde Jørgensen
{"title":"北欧国家的肢端肥大症治疗：德尔菲共识调查。","authors":"Mai C. Arlien-Søborg, Jakob Dal, Ansgar Heck, Kirstine Stochholm, Eigil Husted, Claus Larsen Feltoft, Åse Krogh Rasmussen, Ulla Feldt-Rasmussen, Mikkel Andreassen, Marianne Christina Klose, Torben Leo Nielsen, Marianne Skovsager Andersen, Louise Lehmann Christensen, Jesper Krogh, Anne Jarlov, Jens Bollerslev, Ingrid Nermoen, Marianne Oksnes, Per Dahlqvist, Tommy Olsson, Katarina Berinder, Charlotte Hoybye, Maria Petersson, Anna-karin Akerman, Jeanette Wahlberg, Bertil Ekman, Britt Eden Engstrom, Gudmundur Johannsson, Oskar Ragnarsson, Daniel Olsson, Helga Ágústa Sigurjónsdóttir, Stine Lyngvi Fougner, Niina Matikainen, Satu Vehkavaara, Saara Metso, Pia Jaatinen, Päivi Hämäläinen, Reeta Rintamäki, Iina Yliaska, Heidi Immonen, Sari Mäkimattila, Henna Cederberg-Tamminen, Marianna Viukari, Pasi Nevalainen, Pirjo Nuutila, Camilla Schalin-Jäntti, Pia Burman, Jens Otto Lunde Jørgensen","doi":"10.1111/cen.15095","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Objective</h3>\n \n <p>Acromegaly is associated with increased morbidity and mortality if left untreated. The therapeutic options include surgery, medical treatment, and radiotherapy. Several guidelines and recommendations on treatment algorithms and follow-up exist. However, not all recommendations are strictly evidence-based. To evaluate consensus on the treatment and follow-up of patients with acromegaly in the Nordic countries.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>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 (<i>n</i> = 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.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>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.</p>\n </section>\n \n <section>\n \n <h3> Conclusion</h3>\n \n <p>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.</p>\n </section>\n </div>","PeriodicalId":10346,"journal":{"name":"Clinical Endocrinology","volume":null,"pages":null},"PeriodicalIF":3.0000,"publicationDate":"2024-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cen.15095","citationCount":"0","resultStr":"{\"title\":\"Acromegaly management in the Nordic countries: A Delphi consensus survey\",\"authors\":\"Mai C. 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The therapeutic options include surgery, medical treatment, and radiotherapy. Several guidelines and recommendations on treatment algorithms and follow-up exist. However, not all recommendations are strictly evidence-based. To evaluate consensus on the treatment and follow-up of patients with acromegaly in the Nordic countries.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Methods</h3>\\n \\n <p>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 (<i>n</i> = 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.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Results</h3>\\n \\n <p>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. 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Acromegaly management in the Nordic countries: A Delphi consensus survey
Objective
Acromegaly is associated with increased morbidity and mortality if left untreated. The therapeutic options include surgery, medical treatment, and radiotherapy. Several guidelines and recommendations on treatment algorithms and follow-up exist. However, not all recommendations are strictly evidence-based. To evaluate consensus on the treatment and follow-up of patients with acromegaly in the Nordic countries.
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.
期刊介绍：
Clinical Endocrinology publishes papers and reviews which focus on the clinical aspects of endocrinology, including the clinical application of molecular endocrinology. It does not publish papers relating directly to diabetes care and clinical management. It features reviews, original papers, commentaries, correspondence and Clinical Questions. Clinical Endocrinology is essential reading not only for those engaged in endocrinological research but also for those involved primarily in clinical practice.
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