Acromegaly management in the Nordic countries: A Delphi consensus survey

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

Acromegaly management in the Nordic countries: A Delphi consensus survey

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 OlssonKatarina 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

^*Corresponding author for this work

Research output: Contribution to journal › Journal article › Research › peer-review

Abstract

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.

Original language	English
Journal	Clinical Endocrinology
Volume	101
Issue number	3
Pages (from-to)	263-273
ISSN	0300-0664
DOIs	https://doi.org/10.1111/cen.15095
Publication status	Published - Sept 2024

Keywords

acromegaly
Delphi
dopamine agonist
growth hormone
growth hormone receptor antagonist
insulin-like growth factor i
somatostatin
Humans
Consensus
Scandinavian and Nordic Countries/epidemiology
Delphi Technique
Acromegaly/therapy
Human Growth Hormone/therapeutic use
Surveys and Questionnaires
Somatostatin/analogs & derivatives

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10.1111/cen.15095Licence: CC BY-NC-ND

Open Access VersionFinal published version, 836 KBLicence: CC BY-NC-ND

Cite this

Arlien-Søborg, M. C., Dal, J., Heck, A., Stochholm, K., Husted, E., Feltoft, C. L., Rasmussen, Å. K., Feldt-Rasmussen, U., Andreassen, M., Klose, M. C., Nielsen, T. L., Andersen, M. S., Christensen, L. L., Krogh, J., Jarlov, A., Bollerslev, J., Nermoen, I., Oksnes, M., Dahlqvist, P., ... Jørgensen, J. O. L. (2024). Acromegaly management in the Nordic countries: A Delphi consensus survey. Clinical Endocrinology, 101(3), 263-273. https://doi.org/10.1111/cen.15095

@article{630ec467b5b64c538598dd205fcb5303,

title = "Acromegaly management in the Nordic countries: A Delphi consensus survey",

abstract = "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.",

keywords = "acromegaly, Delphi, dopamine agonist, growth hormone, growth hormone receptor antagonist, insulin-like growth factor i, somatostatin, Humans, Consensus, Scandinavian and Nordic Countries/epidemiology, Delphi Technique, Acromegaly/therapy, Human Growth Hormone/therapeutic use, Surveys and Questionnaires, Somatostatin/analogs & derivatives",

author = "Arlien-S{\o}borg, {Mai C.} and Jakob Dal and Ansgar Heck and Kirstine Stochholm and Eigil Husted and Feltoft, {Claus Larsen} and Rasmussen, {{\AA}se Krogh} and Ulla Feldt-Rasmussen and Mikkel Andreassen and Klose, {Marianne Christina} and Nielsen, {Torben Leo} and Andersen, {Marianne Skovsager} and Christensen, {Louise Lehmann} and Jesper Krogh and Anne Jarlov and Jens Bollerslev and Ingrid Nermoen and Marianne Oksnes and Per Dahlqvist and Tommy Olsson and Katarina Berinder and Charlotte Hoybye and Maria Petersson and Akerman, {Anna karin} and Jeanette Wahlberg and Bertil Ekman and Engstrom, {Britt Eden} and Gudmundur Johannsson and Oskar Ragnarsson and Daniel Olsson and Sigurj{\'o}nsd{\'o}ttir, {Helga {\'A}g{\'u}sta} and Fougner, {Stine Lyngvi} and Niina Matikainen and Satu Vehkavaara and Saara Metso and Pia Jaatinen and P{\"a}ivi H{\"a}m{\"a}l{\"a}inen and Reeta Rintam{\"a}ki and Iina Yliaska and Heidi Immonen and Sari M{\"a}kimattila and Henna Cederberg-Tamminen and Marianna Viukari and Pasi Nevalainen and Pirjo Nuutila and Camilla Schalin-J{\"a}ntti and Pia Burman and J{\o}rgensen, {Jens Otto Lunde}",

year = "2024",

month = sep,

doi = "10.1111/cen.15095",

language = "English",

volume = "101",

pages = "263--273",

journal = "Clinical Endocrinology",

issn = "0300-0664",

publisher = "Wiley",

number = "3",

}

Arlien-Søborg, MC, Dal, J, Heck, A, Stochholm, K, Husted, E, Feltoft, CL, Rasmussen, ÅK, Feldt-Rasmussen, U, Andreassen, M, Klose, MC, Nielsen, TL , Andersen, MS , Christensen, LL, Krogh, J, Jarlov, A, Bollerslev, J, Nermoen, I, Oksnes, M, Dahlqvist, P, Olsson, T, Berinder, K, Hoybye, C, Petersson, M, Akerman, AK, Wahlberg, J, Ekman, B, Engstrom, BE, Johannsson, G, Ragnarsson, O, Olsson, D, Sigurjónsdóttir, HÁ, Fougner, SL, Matikainen, N, Vehkavaara, S, Metso, S, Jaatinen, P, Hämäläinen, P, Rintamäki, R, Yliaska, I, Immonen, H, Mäkimattila, S, Cederberg-Tamminen, H, Viukari, M, Nevalainen, P, Nuutila, P, Schalin-Jäntti, C, Burman, P & Jørgensen, JOL 2024, 'Acromegaly management in the Nordic countries: A Delphi consensus survey', Clinical Endocrinology, vol. 101, no. 3, pp. 263-273. https://doi.org/10.1111/cen.15095

TY - JOUR

T1 - Acromegaly management in the Nordic countries: A Delphi consensus survey

AU - Arlien-Søborg, Mai C.

AU - Dal, Jakob

AU - Heck, Ansgar

AU - Stochholm, Kirstine

AU - Husted, Eigil

AU - Feltoft, Claus Larsen

AU - Rasmussen, Åse Krogh

AU - Feldt-Rasmussen, Ulla

AU - Andreassen, Mikkel

AU - Klose, Marianne Christina

AU - Nielsen, Torben Leo

AU - Andersen, Marianne Skovsager

AU - Christensen, Louise Lehmann

AU - Krogh, Jesper

AU - Jarlov, Anne

AU - Bollerslev, Jens

AU - Nermoen, Ingrid

AU - Oksnes, Marianne

AU - Dahlqvist, Per

AU - Olsson, Tommy

AU - Berinder, Katarina

AU - Hoybye, Charlotte

AU - Petersson, Maria

AU - Akerman, Anna karin

AU - Wahlberg, Jeanette

AU - Ekman, Bertil

AU - Engstrom, Britt Eden

AU - Johannsson, Gudmundur

AU - Ragnarsson, Oskar

AU - Olsson, Daniel

AU - Sigurjónsdóttir, Helga Ágústa

AU - Fougner, Stine Lyngvi

AU - Matikainen, Niina

AU - Vehkavaara, Satu

AU - Metso, Saara

AU - Jaatinen, Pia

AU - Hämäläinen, Päivi

AU - Rintamäki, Reeta

AU - Yliaska, Iina

AU - Immonen, Heidi

AU - Mäkimattila, Sari

AU - Cederberg-Tamminen, Henna

AU - Viukari, Marianna

AU - Nevalainen, Pasi

AU - Nuutila, Pirjo

AU - Schalin-Jäntti, Camilla

AU - Burman, Pia

AU - Jørgensen, Jens Otto Lunde

PY - 2024/9

Y1 - 2024/9

N2 - 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.

AB - 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.

KW - acromegaly

KW - Delphi

KW - dopamine agonist

KW - growth hormone

KW - growth hormone receptor antagonist

KW - insulin-like growth factor i

KW - somatostatin

KW - Humans

KW - Consensus

KW - Scandinavian and Nordic Countries/epidemiology

KW - Delphi Technique

KW - Acromegaly/therapy

KW - Human Growth Hormone/therapeutic use

KW - Surveys and Questionnaires

KW - Somatostatin/analogs & derivatives

U2 - 10.1111/cen.15095

DO - 10.1111/cen.15095

M3 - Journal article

C2 - 38865284

AN - SCOPUS:85195918201

SN - 0300-0664

VL - 101

SP - 263

EP - 273

JO - Clinical Endocrinology

JF - Clinical Endocrinology

IS - 3

ER -

Acromegaly management in the Nordic countries: A Delphi consensus survey

Abstract

Keywords

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