Management of patients with acromegaly in clinical practice in the gulf countries: a Delphi consensus survey
BackgroundAcromegaly 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.MethodsA thre...
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Frontiers Media S.A.
2025-06-01
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| Series: | Frontiers in Endocrinology |
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| author | Mussa H. Almalki Mussa H. Almalki Tarik Elhadd Khaled M. AlDahmani Khaled M. AlDahmani Khaled M. AlDahmani Aishah Ekhzaimy Abdullah Alqanaei Hasan Frookh Arwa Alyamani Osamah Hakami Zeinab Dabbous Zaina Rohani Wael Almistehi Hazem Aljumah Abdulla Alfutaisi Alaaeldin Bashier Moeber Mahzari Moeber Mahzari Moeber Mahzari |
| author_facet | Mussa H. Almalki Mussa H. Almalki Tarik Elhadd Khaled M. AlDahmani Khaled M. AlDahmani Khaled M. AlDahmani Aishah Ekhzaimy Abdullah Alqanaei Hasan Frookh Arwa Alyamani Osamah Hakami Zeinab Dabbous Zaina Rohani Wael Almistehi Hazem Aljumah Abdulla Alfutaisi Alaaeldin Bashier Moeber Mahzari Moeber Mahzari Moeber Mahzari |
| author_sort | Mussa H. Almalki |
| collection | DOAJ |
| description | BackgroundAcromegaly 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.MethodsA 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.ResultsStrong 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.DiscussionThese 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. |
| format | Article |
| id | doaj-art-70e6cb29aab14275a6b53e7dcbee1dc2 |
| institution | OA Journals |
| issn | 1664-2392 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Endocrinology |
| spelling | doaj-art-70e6cb29aab14275a6b53e7dcbee1dc22025-08-20T02:23:06ZengFrontiers Media S.A.Frontiers in Endocrinology1664-23922025-06-011610.3389/fendo.2025.15939591593959Management of patients with acromegaly in clinical practice in the gulf countries: a Delphi consensus surveyMussa H. Almalki0Mussa H. Almalki1Tarik Elhadd2Khaled M. AlDahmani3Khaled M. AlDahmani4Khaled M. AlDahmani5Aishah Ekhzaimy6Abdullah Alqanaei7Hasan Frookh8Arwa Alyamani9Osamah Hakami10Zeinab Dabbous11Zaina Rohani12Wael Almistehi13Hazem Aljumah14Abdulla Alfutaisi15Alaaeldin Bashier16Moeber Mahzari17Moeber Mahzari18Moeber Mahzari19Obesity, Endocrine, and Metabolism Center, King Fahad Medical City, Second Health Cluster Riyadh, Riyadh, Saudi ArabiaCollege of Medicine, Alfaisal University, Riyadh, Saudi ArabiaEndocrine Section, Department of Medicine, Hamad Medical Corporation, Doha, QatarDivision of Endocrinology, Department of Medicine, Tawam Hospital, SEHA, PureHealth, Al Ain, United Arab EmiratesAdjunct Faculty, Department of Internal Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab EmiratesDivision of Endocrinology, Department of Medicine, Sheikh Tahnoon Bin Mohammed Medical City, SEHA, PureHealth, Al Ain, United Arab EmiratesEndocrinology and Diabetes Unit, Department of Medicine, College of Medicine and King Saud University Medical City, King Saud University, Riyadh, Saudi ArabiaDivision of Endocrinology, Department of Medicine, Sabah Hospital, Kuwait, KuwaitDivision of Endocrine & Diabetes, Salmanyia Medical Complex, Governmental Hospital, Ministry of Health, Manama, Bahrain0Endocrine Division of Internal Medicine Department, King Abdullah Medical City in Holy Capital (KAMC-HC), Makkah, Saudi Arabia0Endocrine Division of Internal Medicine Department, King Abdullah Medical City in Holy Capital (KAMC-HC), Makkah, Saudi ArabiaEndocrine Section, Department of Medicine, Hamad Medical Corporation, Doha, QatarEndocrine Section, Department of Medicine, Hamad Medical Corporation, Doha, QatarObesity, Endocrine, and Metabolism Center, King Fahad Medical City, Second Health Cluster Riyadh, Riyadh, Saudi Arabia1Division of Endocrinology, Department of Internal Medicine, Prince Mohammed bin Abdulaziz Hospital, Riyadh, Saudi Arabia2Department of Medicine, College of Medicine, Sultan Qaboos University, Muscat, Oman3Division of Endocrinology, Department of Medicine, Dubai Hospital, Dubai, United Arab Emirates4College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia5King Abdullah International Medical Research Center, Riyadh, Saudi Arabia6Department of Medicine, Ministry of National Guard Health Affairs, Riyadh, Saudi ArabiaBackgroundAcromegaly 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.MethodsA 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.ResultsStrong 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.DiscussionThese 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.https://www.frontiersin.org/articles/10.3389/fendo.2025.1593959/fullgulf region consensusdelphi consensussurveyacromegalytreatmentsurgery |
| spellingShingle | Mussa H. Almalki Mussa H. Almalki Tarik Elhadd Khaled M. AlDahmani Khaled M. AlDahmani Khaled M. AlDahmani Aishah Ekhzaimy Abdullah Alqanaei Hasan Frookh Arwa Alyamani Osamah Hakami Zeinab Dabbous Zaina Rohani Wael Almistehi Hazem Aljumah Abdulla Alfutaisi Alaaeldin Bashier Moeber Mahzari Moeber Mahzari Moeber Mahzari Management of patients with acromegaly in clinical practice in the gulf countries: a Delphi consensus survey Frontiers in Endocrinology gulf region consensus delphi consensus survey acromegaly treatment surgery |
| title | Management of patients with acromegaly in clinical practice in the gulf countries: a Delphi consensus survey |
| title_full | Management of patients with acromegaly in clinical practice in the gulf countries: a Delphi consensus survey |
| title_fullStr | Management of patients with acromegaly in clinical practice in the gulf countries: a Delphi consensus survey |
| title_full_unstemmed | Management of patients with acromegaly in clinical practice in the gulf countries: a Delphi consensus survey |
| title_short | Management of patients with acromegaly in clinical practice in the gulf countries: a Delphi consensus survey |
| title_sort | management of patients with acromegaly in clinical practice in the gulf countries a delphi consensus survey |
| topic | gulf region consensus delphi consensus survey acromegaly treatment surgery |
| url | https://www.frontiersin.org/articles/10.3389/fendo.2025.1593959/full |
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