肢端肥大症诊断和缓解标准的一致性。

IF 3.3 2区 医学 Q2 ENDOCRINOLOGY & METABOLISM
Pituitary Pub Date : 2024-02-01 Epub Date: 2023-11-03 DOI:10.1007/s11102-023-01360-1
Andrea Giustina, Nienke Biermasz, Felipe F Casanueva, Maria Fleseriu, Pietro Mortini, Christian Strasburger, A J van der Lely, John Wass, Shlomo Melmed
{"title":"肢端肥大症诊断和缓解标准的一致性。","authors":"Andrea Giustina, Nienke Biermasz, Felipe F Casanueva, Maria Fleseriu, Pietro Mortini, Christian Strasburger, A J van der Lely, John Wass, Shlomo Melmed","doi":"10.1007/s11102-023-01360-1","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>The 14th Acromegaly Consensus Conference was convened to consider biochemical criteria for acromegaly diagnosis and evaluation of therapeutic efficacy.</p><p><strong>Methods: </strong>Fifty-six acromegaly experts from 16 countries reviewed and discussed current evidence focused on biochemical assays; criteria for diagnosis and the role of imaging, pathology, and clinical assessments; consequences of diagnostic delay; criteria for remission and recommendations for follow up; and the value of assessment and monitoring in defining disease progression, selecting appropriate treatments, and maximizing patient outcomes.</p><p><strong>Results: </strong>In a patient with typical acromegaly features, insulin-like growth factor (IGF)-I > 1.3 times the upper limit of normal for age confirms the diagnosis. Random growth hormone (GH) measured after overnight fasting may be useful for informing prognosis, but is not required for diagnosis. For patients with equivocal results, IGF-I measurements using the same validated assay can be repeated, and oral glucose tolerance testing might also be useful. Although biochemical remission is the primary assessment of treatment outcome, biochemical findings should be interpreted within the clinical context of acromegaly. Follow up assessments should consider biochemical evaluation of treatment effectiveness, imaging studies evaluating residual/recurrent adenoma mass, and clinical signs and symptoms of acromegaly, its complications, and comorbidities. Referral to a multidisciplinary pituitary center should be considered for patients with equivocal biochemical, pathology, or imaging findings at diagnosis, and for patients insufficiently responsive to standard treatment approaches.</p><p><strong>Conclusion: </strong>Consensus recommendations highlight new understandings of disordered GH and IGF-I in patients with acromegaly and the importance of expert management for this rare disease.</p>","PeriodicalId":20202,"journal":{"name":"Pituitary","volume":null,"pages":null},"PeriodicalIF":3.3000,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10837217/pdf/","citationCount":"0","resultStr":"{\"title\":\"Consensus on criteria for acromegaly diagnosis and remission.\",\"authors\":\"Andrea Giustina, Nienke Biermasz, Felipe F Casanueva, Maria Fleseriu, Pietro Mortini, Christian Strasburger, A J van der Lely, John Wass, Shlomo Melmed\",\"doi\":\"10.1007/s11102-023-01360-1\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>The 14th Acromegaly Consensus Conference was convened to consider biochemical criteria for acromegaly diagnosis and evaluation of therapeutic efficacy.</p><p><strong>Methods: </strong>Fifty-six acromegaly experts from 16 countries reviewed and discussed current evidence focused on biochemical assays; criteria for diagnosis and the role of imaging, pathology, and clinical assessments; consequences of diagnostic delay; criteria for remission and recommendations for follow up; and the value of assessment and monitoring in defining disease progression, selecting appropriate treatments, and maximizing patient outcomes.</p><p><strong>Results: </strong>In a patient with typical acromegaly features, insulin-like growth factor (IGF)-I > 1.3 times the upper limit of normal for age confirms the diagnosis. Random growth hormone (GH) measured after overnight fasting may be useful for informing prognosis, but is not required for diagnosis. For patients with equivocal results, IGF-I measurements using the same validated assay can be repeated, and oral glucose tolerance testing might also be useful. Although biochemical remission is the primary assessment of treatment outcome, biochemical findings should be interpreted within the clinical context of acromegaly. Follow up assessments should consider biochemical evaluation of treatment effectiveness, imaging studies evaluating residual/recurrent adenoma mass, and clinical signs and symptoms of acromegaly, its complications, and comorbidities. Referral to a multidisciplinary pituitary center should be considered for patients with equivocal biochemical, pathology, or imaging findings at diagnosis, and for patients insufficiently responsive to standard treatment approaches.</p><p><strong>Conclusion: </strong>Consensus recommendations highlight new understandings of disordered GH and IGF-I in patients with acromegaly and the importance of expert management for this rare disease.</p>\",\"PeriodicalId\":20202,\"journal\":{\"name\":\"Pituitary\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":3.3000,\"publicationDate\":\"2024-02-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10837217/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Pituitary\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1007/s11102-023-01360-1\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2023/11/3 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q2\",\"JCRName\":\"ENDOCRINOLOGY & METABOLISM\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Pituitary","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s11102-023-01360-1","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2023/11/3 0:00:00","PubModel":"Epub","JCR":"Q2","JCRName":"ENDOCRINOLOGY & METABOLISM","Score":null,"Total":0}
引用次数: 0

摘要

目的:召开第14届肢端肥大症共识会议,审议肢端肥大诊断和疗效评估的生化标准。方法:来自16个国家的56名肢端肥大症专家回顾并讨论了目前的生物化学分析证据;诊断标准以及影像学、病理学和临床评估的作用;诊断延误的后果;缓解标准和随访建议;以及评估和监测在确定疾病进展、选择适当的治疗方法和最大限度地提高患者疗效方面的价值。结果:在具有典型肢端肥大症特征的患者中,胰岛素样生长因子(IGF)-I > 年龄正常上限的1.3倍证实了诊断。夜间禁食后测量的随机生长激素(GH)可能有助于判断预后,但不是诊断所必需的。对于结果不明确的患者,可以重复使用相同验证的测定法进行IGF-I测量,口服葡萄糖耐量测试也可能有用。尽管生化缓解是治疗结果的主要评估,但生化结果应在肢端肥大症的临床背景下进行解释。随访评估应考虑治疗效果的生化评估、评估残留/复发腺瘤肿块的影像学研究、肢端肥大症的临床体征和症状、并发症和合并症。对于诊断时生化、病理或成像结果不明确的患者,以及对标准治疗方法反应不足的患者,应考虑转诊至多学科垂体中心。结论:一致的建议强调了对肢端肥大症患者GH和IGF-I紊乱的新认识,以及专家管理对这种罕见疾病的重要性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Consensus on criteria for acromegaly diagnosis and remission.

Purpose: The 14th Acromegaly Consensus Conference was convened to consider biochemical criteria for acromegaly diagnosis and evaluation of therapeutic efficacy.

Methods: Fifty-six acromegaly experts from 16 countries reviewed and discussed current evidence focused on biochemical assays; criteria for diagnosis and the role of imaging, pathology, and clinical assessments; consequences of diagnostic delay; criteria for remission and recommendations for follow up; and the value of assessment and monitoring in defining disease progression, selecting appropriate treatments, and maximizing patient outcomes.

Results: In a patient with typical acromegaly features, insulin-like growth factor (IGF)-I > 1.3 times the upper limit of normal for age confirms the diagnosis. Random growth hormone (GH) measured after overnight fasting may be useful for informing prognosis, but is not required for diagnosis. For patients with equivocal results, IGF-I measurements using the same validated assay can be repeated, and oral glucose tolerance testing might also be useful. Although biochemical remission is the primary assessment of treatment outcome, biochemical findings should be interpreted within the clinical context of acromegaly. Follow up assessments should consider biochemical evaluation of treatment effectiveness, imaging studies evaluating residual/recurrent adenoma mass, and clinical signs and symptoms of acromegaly, its complications, and comorbidities. Referral to a multidisciplinary pituitary center should be considered for patients with equivocal biochemical, pathology, or imaging findings at diagnosis, and for patients insufficiently responsive to standard treatment approaches.

Conclusion: Consensus recommendations highlight new understandings of disordered GH and IGF-I in patients with acromegaly and the importance of expert management for this rare disease.

求助全文
通过发布文献求助,成功后即可免费获取论文全文。 去求助
来源期刊
Pituitary
Pituitary 医学-内分泌学与代谢
CiteScore
7.10
自引率
7.90%
发文量
90
审稿时长
6 months
期刊介绍: Pituitary is an international publication devoted to basic and clinical aspects of the pituitary gland. It is designed to publish original, high quality research in both basic and pituitary function as well as clinical pituitary disease. The journal considers: Biology of Pituitary Tumors Mechanisms of Pituitary Hormone Secretion Regulation of Pituitary Function Prospective Clinical Studies of Pituitary Disease Critical Basic and Clinical Reviews Pituitary is directed at basic investigators, physiologists, clinical adult and pediatric endocrinologists, neurosurgeons and reproductive endocrinologists interested in the broad field of the pituitary and its disorders. The Editorial Board has been drawn from international experts in basic and clinical endocrinology. The journal offers a rapid turnaround time for review of manuscripts, and the high standard of the journal is maintained by a selective peer-review process which aims to publish only the highest quality manuscripts. Pituitary will foster the publication of creative scholarship as it pertains to the pituitary and will provide a forum for basic scientists and clinicians to publish their high quality pituitary-related work.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信