Background: Acromegaly treatment options include transsphenoidal surgery (TSS), medical management with somatostatin analogues (SSAs), growth hormone (GH) receptor antagonists and dopamine agonists, radiotherapy or a combination of these, depending on symptom nature and severity, tumour size, age and health status. In 2014 the Endocrine Society published guidelines for management of acromegaly.
Methods: To describe current UK practice following guideline publication, between November 2014 and March 2015 we conducted telephone or face-to-face surveys of 21 endocrinologists from 19 UK secondary/tertiary care NHS centres on local management of acromegaly, biochemical control criteria and factors driving treatment decisions.
Results: The estimated number of new patients seen per year ranged between centres from 1 to 20 and the number of existing patients from 11 to 250. Most common referral sources (not mutually exclusive) were other endocrinologists (n=14) and general practitioners (n=12). All respondents stated that both IGF1 and GH are important for assessing biochemical control; the local biochemical control criteria were GH<1.0 ng/ml (n=17) and IGF1 <upper limit of normal (n=19). For 12/21 the possible effect on tumour volume is an important criterion for treatment choice. In rating the importance of biochemical vs symptomatic control for treatment decision-making (visual analogue scale: 0=symptomatic control; 100=biochemical control) the median score was 70 (range 2288); 12/21 considered biochemical control most important. TSS was the most common first-line therapy and medical management (usually SSAs) most common following TSS failure. There was considerable variation in the reported proportion of patients who receive radiotherapy following surgical failure. Although reported as least common, visual failure and cardiomyopathy were most likely to drive management change.
Conclusions: This survey relied upon clinical opinion of a limited number of clinicians; nevertheless, it provides useful insights into current acromegaly management by UK endocrinologists. It highlights variation in practice and some guideline recommendations not yet fully embedded, requiring further exploration.