Hadden Lecture outlines the modern management of acromegaly

This year’s Hadden Lecture during the IES Annual Meeting was titled ‘The Modern Management of Acromegaly’, and was delivered by Prof William Drake, Professor of Clinical Endocrinology in St Bartholomew’s Hospital, London, UK, who specialises in pituitary, adrenal, thyroid and parathyroid disease.

Acromegaly is a hormonal disorder that results from too much growth hormone (GH) in the body. In acromegaly, the pituitary produces excessive amounts of GH. Usually the excess GH comes from benign, or non-cancerous, tumours on the pituitary (adenomas).

Acromegaly is most often diagnosed in middle-aged adults, although symptoms can appear at any age. If not treated, acromegaly can result in serious illness and premature death. Acromegaly is treatable in most patients, but is often not diagnosed early or correctly. The most serious health consequences of acromegaly are type 2 diabetes, high blood pressure, increased risk of cardiovascular disease, and arthritis. Patients with acromegaly are also at increased risk for colon polyps, which may develop into colon cancer if not removed.

In terms of treatment, medications used to lower the production or block the action of GH include somatostatin analogues; dopamine agonists; and pegvisomant.

Cortisol metabolism is corrected by SMS analogues and pegvisomant, while glucose tolerance improves with DA agonists and pegvisomant. Pegvisomant has the ability, at the correct dose, to control SSA-resistant patients and indices of glycaemic regulation can improve on moving from SSAs to pegvisomant, according to Prof Drake. The lecture was very well received by delegates attending the meeting.

Dr Diarmuid Smith, Consultant Endocrinologist, Beaumont Hospital, Dublin, praised the lecture as “wonderful”. “I thought it was a great lecture… I think the point that he was really trying to… hammer home was guidelines are great, but you have to take the patient as a whole person. You can apply guidelines to help decision-making, but the patient in front of you — you have to make judgments on behalf of that patient,” he said.

“You need to listen to your patient, you need to understand your patient, develop a relationship with your patient. One of the great things about our specialty is chronic illness management, so we get to know our patients over time. And that the patient has to be the core of everything.”

Prof Mark Sherlock, also a Consultant Endocrinologist based in Beaumont Hospital, described the Hadden Lecture as a highlight of the weekend.

“I thought [Prof] Will Drake’s lecture… was a fantastic overview from a really expert clinician, on how best to manage patients with acromegaly, and how sometimes you need to individualise treatment to patients rather than just following the guidelines,” said Prof Sherlock.

He said that Prof Drake “showed some data from his centre showing really impressive results about pre-treating people medically with certain medications prior to surgery, the research he’d done around the area of dopamine agonists. So it was a really good overview for trainees particularly, and a lot of clinicians.”

The meeting’s local organiser, Dr Marcia Bell, Consultant Endocrinologist in Galway University Hospital, described the lecture as “super”. She said: “[Prof] Will Drake I would have expected to give a fantastic talk — I think he did, he was warm… there was a great update, but also a real humane side to his talk. So it was excellent and I think there was great feedback from it.”