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.
CONCLUSIONS: 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.
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.
CONCLUSIONS: 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.
摘要：
目的：如果不治疗，肢端肥大症会增加发病率和死亡率。治疗方案包括手术,医疗,和放射治疗。存在关于治疗算法和随访的若干指南和建议。然而,并非所有建议都是严格以证据为基础的.评估北欧国家肢端肥大症患者治疗和随访的共识。
方法：使用Delphi过程来绘制丹麦肢端肥大症管理的图景，瑞典,挪威,芬兰,和冰岛。专家小组就肢端肥大症患者的治疗和随访制定了37项声明。来自北欧国家的专门的内分泌学家（n=47）被邀请对他们与声明的一致程度进行评分，使用李克特型量表（1-7）。共识被定义为≥80％的小组成员在李克特型量表上将他们的共识评为≥5或≤3。
结果：41%（15/37）的陈述达成共识。小组成员同意垂体手术仍然是一线治疗。普遍同意在手术失败后推荐第一代生长抑素类似物（SSA）治疗并考虑重复手术。此外,对于推荐使用第一代SSA和pegvisomant的联合治疗作为二线或三线治疗存在一致意见.在超过50%的陈述中，没有达成共识。关于pegvisomant单药治疗存在相当大的分歧，用帕瑞肽和多巴胺激动剂治疗。
结论：这项关于北欧国家肢端肥大症患者管理的共识探索研究揭示了专家之间相对较大程度的分歧，这反映了疾病的复杂性和基于证据的数据的短缺。
方法：使用Delphi过程来绘制丹麦肢端肥大症管理的图景，瑞典,挪威,芬兰,和冰岛。专家小组就肢端肥大症患者的治疗和随访制定了37项声明。来自北欧国家的专门的内分泌学家（n=47）被邀请对他们与声明的一致程度进行评分，使用李克特型量表（1-7）。共识被定义为≥80％的小组成员在李克特型量表上将他们的共识评为≥5或≤3。
结果：41%（15/37）的陈述达成共识。小组成员同意垂体手术仍然是一线治疗。普遍同意在手术失败后推荐第一代生长抑素类似物（SSA）治疗并考虑重复手术。此外,对于推荐使用第一代SSA和pegvisomant的联合治疗作为二线或三线治疗存在一致意见.在超过50%的陈述中，没有达成共识。关于pegvisomant单药治疗存在相当大的分歧，用帕瑞肽和多巴胺激动剂治疗。
结论：这项关于北欧国家肢端肥大症患者管理的共识探索研究揭示了专家之间相对较大程度的分歧，这反映了疾病的复杂性和基于证据的数据的短缺。
