Multidisciplinary management of acromegaly: A consensus.

The 13th Acromegaly Consensus Conference was held in November 2019 in Fort Lauderdale, Florida, and comprised acromegaly experts including endocrinologists and neurosurgeons who considered optimal approaches for multidisciplinary acromegaly management. Focused discussions reviewed techniques, results, and side effects of surgery, radiotherapy, and medical therapy, and how advances in technology and novel techniques have changed the way these modalities are used alone or in combination. Effects of treatment on patient outcomes were considered, along with strategies for optimizing and personalizing therapeutic approaches. Expert consensus recommendations emphasize how best to implement available treatment options as part of a multidisciplinary approach at Pituitary Tumor Centers of Excellence

MRI assessment of lean and adipose tissue distribution in female patients with Cushing's disease

OBJECTIVE: Chronic hypercortisolemia due to Cushing’s Disease (CD) results in abnormal adipose tissue (AT) distribution. Whole-body magnetic resonance imaging (MRI) was used to examine lean and AT distribution in female patients with CD to further understand the role of glucocorticoid excess in the development of abnormal AT distribution and obesity. DESIGN: Cross-sectional and case control study. PATIENTS: 15 females with CD and 12 healthy controls. MEASUREMENTS: Mass of skeletal muscle (SM) and AT in the visceral (VAT), subcutaneous (SAT), and inter-muscular (IMAT) compartments from whole-body MRI and serum levels of insulin, glucose, and leptin were measured. RESULTS: CD patients had leptin values that correlated to total AT (TAT) and SAT (p < 0.05) but not to VAT. CD patients had higher VAT/TAT ratios (p < 0.01) and lower SAT/TAT ratios (p < 0.05) compared to controls. TAT, VAT, and trunk SAT (TrSAT) were greater in CD patients (p < 0.01). SM was less in CD (p < 0.001) but IMAT was not different. CONCLUSIONS: TAT, VAT, trSAT, and the proportion of AT in the visceral depot were greater in CD, though the proportion in the subcutaneous depot was less. SM was less but IMAT was not different. These findings have implications for understanding the role of cortisol in the abnormal AT distribution and metabolic risk seen in patients exposed to chronic excess glucocorticoids