Endocrine Abstracts

Personalized medicine aims at providing indications concerning the management of each patient according to her/his specific needs and disease characteristics. Acromegaly, although a rare disease, has a profound impact on patients’ quality and expectancy of life, due to increased morbidity and mortality as compared to the general population in correlation mainly due to cardiovascular disease and cancer. Several clinical variables have been investigated as predictors of response to treatment (either surgical or medical) and as prognostic factors. Tumor diameter, invasiveness, genetic predisposition are recognized as the main predictors for surgical success. Adenoma granulation at electron microscopy, somatostatin receptor status, T2-intensity at MRI, age, and AIP mutation status have been indicated as predictive of response to treatment with somatostatin receptor ligands (SRLs). If resistance to SRL is foreseen, treatment with the growth hormone receptor antagonist pegvisomant or second-generation SRL pasireotide can be proposed, with the possibility of a combination therapy. In addition to tumor characteristics, a very important issue is represented by assessment of symptoms and of quality of life (QoL). Several quaestionnaires have been developed to specifically evaluate QoL in patients with acromegaly. The patient-assessed acromegaly symptom questionnaire consists of 5 acromegaly-related symptoms (soft-tissue swelling, arthralgia, headache, excessive perspiration, and fatigue) has not yet been clinically validated. The acromegaly quality of life questionnaire is used to assess the disease-specific physical and psychologic aspects. The acromegaly treatment satisfaction questionnaire is clinically validated to assess patient satisfaction with monthly injectable SRLs. Therefore, several items are available to clinicians to aid the best therapeutic managements of acromegaly and its complications on the basis of patient charcteristics, but also (and mainly) on the basis of patiet’s choice and specific health issues.