Acromegaly management in the Nordic countries: A Delphi consensus survey

Area of Science:

• Endocrinology
• Clinical Medicine
• Medical Guidelines

Background:

• Acromegaly, a condition of excess growth hormone, carries significant morbidity and mortality risks if untreated.
• Current treatment options include surgery, medical therapy, and radiotherapy, with existing guidelines lacking strong evidence.
• Evaluating expert consensus on acromegaly management in Nordic countries is crucial for refining treatment protocols.

Purpose of the Study:

• To assess the level of agreement among Nordic experts regarding the treatment and follow-up of acromegaly patients.
• To identify areas of consensus and disagreement in acromegaly management strategies within the Nordic region.

Main Methods:

• A Delphi process involving 47 endocrinologists from Denmark, Sweden, Norway, Finland, and Iceland.
• Development and rating of 37 statements on acromegaly treatment and follow-up using a 7-point Likert scale.
• Consensus defined as ≥80% agreement (score ≥5 or ≤3).

Main Results:

• Consensus was achieved on only 41% (15/37) of the statements, indicating substantial disagreement.
• Experts agreed on pituitary surgery as first-line treatment, with somatostatin analog (SSA) and repeat surgery as options after failure.
• Disagreement was noted regarding pegvisomant monotherapy, pasireotide, and dopamine agonist treatments.

Conclusions:

• A significant degree of expert disagreement exists in acromegaly management across Nordic countries.
• This lack of consensus highlights the complexity of acromegaly and the need for more evidence-based data.
• Findings suggest a need for further research and guideline development to standardize acromegaly care.