Almalki Mussa H, Elhadd Tarik, AlDahmani Khaled M, Ekhzaimy Aishah, Alqanaei Abdullah, Frookh Hasan, Alyamani Arwa, Hakami Osamah, Dabbous Zeinab, Rohani Zaina, Almistehi Wael, Aljumah Hazem, Alfutaisi Abdulla, Bashier Alaaeldin, Mahzari Moeber
Obesity, Endocrine, and Metabolism Center, King Fahad Medical City, Second Health Cluster Riyadh, Riyadh, Saudi Arabia.
College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.
Front Endocrinol (Lausanne). 2025 Jun 12;16:1593959. doi: 10.3389/fendo.2025.1593959. eCollection 2025.
Acromegaly management practices in the Gulf region lack standardized guidelines, leading to variability in care. This study aimed to establish evidence-based regional consensus recommendations to address clinical challenges and align management with local healthcare resources.
A three-round Delphi consensus survey was conducted among 15 endocrinology experts from six Gulf countries. Forty-six statements across six domains-primary treatment, pre-surgery treatment with somatostatin analogs (SSAs), second-line therapy, radiotherapy, post-surgery follow-up, and long-term management-were evaluated. Consensus was predefined as ≥66.8% agreement.
Strong consensus was achieved on surgical resection as first-line therapy for eligible patients (100% agreement), with referrals to multidisciplinary centers emphasized (93.8%). Preoperative SSAs were endorsed to reduce surgical/anesthesia risks in high-risk patients (93.8%). For second-line management, watchful waiting for asymptomatic patients with mildly elevated insulin-like growth factor-1 (IGF-1) (93.8%) and combination therapy (where feasible) were supported. Radiotherapy received unanimous agreement for specific cases. Structured post-surgical follow-up protocols, including biochemical testing timelines and remission criteria, were established. Long-term monitoring emphasized individualized risk assessment.
These guidelines provide a regionally tailored framework for acromegaly management, prioritizing surgery as the cornerstone of treatment while integrating adjuvant therapies and follow-up strategies aligned with Gulf healthcare infrastructures. The consensus reflects pragmatic adaptations to resource availability, such as endorsing watchful waiting in specific contexts. While acknowledging limitations such as potential expert bias, these consensus guidelines provide a framework for standardizing acromegaly care across the Gulf countries, with emphasis on surgical intervention as the cornerstone of treatment while recognizing the importance of adjunctive therapies.
海湾地区肢端肥大症的管理实践缺乏标准化指南，导致护理存在差异。本研究旨在制定基于证据的区域共识建议，以应对临床挑战，并使管理与当地医疗资源相匹配。
对来自六个海湾国家的15名内分泌专家进行了三轮德尔菲共识调查。对六个领域的46项陈述进行了评估，这六个领域包括一线治疗、使用生长抑素类似物（SSA）的术前治疗、二线治疗、放射治疗、术后随访和长期管理。共识被预先定义为≥66.8%的一致同意率。
对于符合条件的患者，手术切除作为一线治疗达成了强烈共识（100%同意），并强调转诊至多学科中心（93.8%）。术前使用SSA被认可用于降低高危患者的手术/麻醉风险（93.8%）。对于二线管理，支持对胰岛素样生长因子-1（IGF-1）轻度升高的无症状患者进行观察等待（93.8%）以及（在可行的情况下）联合治疗。放射治疗在特定病例中获得了一致同意。建立了结构化的术后随访方案，包括生化检测时间线和缓解标准。长期监测强调个体化风险评估。
这些指南为肢端肥大症的管理提供了一个区域定制的框架，将手术作为治疗的基石，同时整合辅助治疗和与海湾地区医疗基础设施相匹配的随访策略。该共识反映了根据资源可用性进行的务实调整，例如在特定情况下认可观察等待。虽然承认存在潜在专家偏见等局限性，但这些共识指南为海湾国家肢端肥大症护理的标准化提供了一个框架，强调手术干预作为治疗的基石，同时认识到辅助治疗的重要性。
