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Current perspectives on the impact of clinical disease and biochemical control on comorbidities and quality of life in acromegaly

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Abstract

Acromegaly is a rare chronic, systemic disorder caused by excessive growth hormone (GH) secretion from a somatotroph pituitary adenoma. GH hypersecretion leads to overproduction of insulin-like growth factor-1 (IGF-1), which contributes to the somatic overgrowth, physical disfigurement, onset of multiple systemic comorbidities, reduced quality of life (QoL) and premature mortality of uncontrolled patients. Somatostatin receptor ligands, dopamine agonists and a GH receptor antagonist are currently available for medical therapy of acromegaly. The main aim of treatment is biochemical normalisation, defined as age-normalised serum IGF-1 values and random GH levels <1.0 μg/L. However, there is an increasing evidence suggesting that achieving biochemical control does not always decrease the burden of disease-related comorbidities and/or improve patients’ QoL. This lack of correlation between biochemical and clinical control can be due to both disease duration (late diagnosis) or to the peculiarity of a given comorbidity. Herein we conducted ad hoc literature searches in order to find the most recent and relevant reports on biochemical and clinical disease control during medical treatment of acromegaly. Particularly, we analyse and describe the relationship between biochemical, as well as clinical disease control in patients with acromegaly receiving medical therapy, with a focus on comorbidities and QoL. In conclusion, we found that current literature data seem to indicate that clinical disease control (besides biochemical control), encompassing clinical signs and symptoms, comorbidities and QoL, emerge as a primary focus of acromegaly patient management.

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Acknowledgments

Financial support for medical editorial assistance was provided by Novartis Pharma AG. We thank Tracy Harrison and Georgii Filatov, Springer Healthcare Communications for the medical writing assistance.

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Authors and Affiliations

  1. Endocrinology Unit, IRCCS Ospedale Policlinico San Martino, 16142, Genoa, Italy

    Federico Gatto, Claudia Campana, Francesco Cocchiara, Giuliana Corica, Mara Boschetti, Massimo Giusti & Diego Ferone

  2. Endocrinology Unit, Department of Internal Medicine and Medical Specialties (DIMI) and Centre of Excellence for Biomedical Research (CEBR), University of Genoa, 16142, Genoa, Italy

    Claudia Campana, Francesco Cocchiara, Giuliana Corica, Manuela Albertelli, Mara Boschetti, Massimo Giusti & Diego Ferone

  3. Neurosurgery Unit, Department of Neurosciences (DINOGMI), IRCCS Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy

    Gianluigi Zona & Diego Criminelli

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  1. Federico Gatto
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FG has been a speaker for Novartis and has participated on advisory boards of Novartis, AMCo Ltd. and IONIS Pharmaceuticals. DF has been a speaker for and participated on advisory boards and received research grants from Novartis and Ipsen. The other Authors have no conflicts of interest to declare.

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Gatto, F., Campana, C., Cocchiara, F. et al. Current perspectives on the impact of clinical disease and biochemical control on comorbidities and quality of life in acromegaly. Rev Endocr Metab Disord 20, 365–381 (2019). https://doi.org/10.1007/s11154-019-09506-y

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