{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,7]],"date-time":"2026-11-07T10:56:27Z","timestamp":1794048987900,"version":"4.8.0"},"reference-count":28,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,6,12]],"date-time":"2025-06-12T00:00:00Z","timestamp":1749686400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A three-round Delphi consensus survey was conducted among 15 endocrinology experts from six Gulf countries. Forty-six statements across six domains\u2014primary treatment, pre-surgery treatment with somatostatin analogs (SSAs), second-line therapy, radiotherapy, post-surgery follow-up, and long-term management\u2014were evaluated. Consensus was predefined as \u226566.8% agreement.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fendo.2025.1593959","type":"journal-article","created":{"date-parts":[[2025,6,12]],"date-time":"2025-06-12T04:10:52Z","timestamp":1749701452000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":5,"title":["Management of patients with acromegaly in clinical practice in the gulf countries: a Delphi consensus survey"],"prefix":"10.3389","volume":"16","author":[{"given":"Mussa H.","family":"Almalki","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tarik","family":"Elhadd","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khaled M.","family":"AlDahmani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aishah","family":"Ekhzaimy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdullah","family":"Alqanaei","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hasan","family":"Frookh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arwa","family":"Alyamani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Osamah","family":"Hakami","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zeinab","family":"Dabbous","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zaina","family":"Rohani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wael","family":"Almistehi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hazem","family":"Aljumah","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdulla","family":"Alfutaisi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alaaeldin","family":"Bashier","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Moeber","family":"Mahzari","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,6,12]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra062453","article-title":"Medical progress: acromegaly","volume":"355","author":"Melmed","year":"2006","journal-title":"N Engl J Med"},{"key":"B2","doi-asserted-by":"publisher","first-page":"20","DOI":"10.1038\/s41572-019-0129-5","article-title":"Acromegaly","volume":"5","author":"Colao","year":"2019","journal-title":"Nat Rev Dis Primers"},{"key":"B3","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/s11102-020-01091-7","article-title":"A pituitary society update to acromegaly management guidelines","volume":"24","author":"Fleseriu","year":"2021","journal-title":"Pituitary"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1007\/s11154-020-09588-z","article-title":"Multidisciplinary management of acromegaly: A consensus","volume":"21","author":"Giustina","year":"2020","journal-title":"Rev Endocr Metab Disord"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1530\/EJE-19-0124","article-title":"Management of endocrine disease: individualised management of acromegaly","volume":"181","author":"Bollerslev","year":"2019","journal-title":"Eur J Endocrinol"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1007\/s11102-016-0753-y","article-title":"Pegvisomant: a growth hormone receptor antagonist used in the treatment of acromegaly","volume":"20","author":"Tritos","year":"2017","journal-title":"Pituitary"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-8587(14)70169-X","article-title":"Pasireotide versus continued treatment with octreotide or lanreotide in patients with inadequately controlled acromegaly (PAOLA): a randomised, phase 3 trial","volume":"2","author":"Gadelha","year":"2014","journal-title":"Lancet Diabetes Endocrinol"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1007\/s42000-018-0045-1","article-title":"Management of acromegaly: an exploratory survey of physicians from the Middle East and North Africa","volume":"17","author":"Ahmad","year":"2018","journal-title":"Hormones (Athens)"},{"key":"B9","doi-asserted-by":"publisher","first-page":"92","DOI":"10.1055\/s-0042-1760392","article-title":"Contemporary management of acromegaly: a practical approach","volume":"5","author":"Almalki","year":"2022","journal-title":"J Diabetes Endocr Pract"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0020476","article-title":"Using and reporting the Delphi method for selecting healthcare quality indicators: a systematic review","volume":"6","author":"Boulkedid","year":"2011","journal-title":"PloS One"},{"key":"B11","unstructured":"The Delphi Method: Techniques and Applications\n          \n          \n            \n              Linstone\n              H\n            \n            \n              Turoff\n              M\n            \n          \n          \n          2002"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM200004203421611","article-title":"Treatment of acromegaly","volume":"342","author":"Utiger","year":"2000","journal-title":"N Engl J Med"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2014-2700","article-title":"Acromegaly: an endocrine society clinical practice guideline","volume":"99","author":"Katznelson","year":"2014","journal-title":"J Clin Endocrinol Metab"},{"key":"B14","doi-asserted-by":"publisher","first-page":"1","DOI":"10.4158\/EP.17.4.636","article-title":"American Association of Clinical Endocrinologists medical guidelines for clinical practice for the diagnosis and treatment of acromegaly\u20142011 update","volume":"17","author":"Katznelson","year":"2011","journal-title":"Endocr Pract"},{"key":"B15","doi-asserted-by":"publisher","first-page":"552","DOI":"10.1038\/s41574-018-0058-5","article-title":"A Consensus Statement on acromegaly therapeutic outcomes","volume":"14","author":"Melmed","year":"2018","journal-title":"Nat Rev Endocrinol"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-8587(22)00244-3","article-title":"Acromegaly: pathogenesis, diagnosis, and management","volume":"10","author":"Fleseriu","year":"2022","journal-title":"Lancet Diabetes Endocrinol"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0061523","article-title":"Place of preoperative treatment of acromegaly with somatostatin analog on surgical outcome: a systematic review and meta-analysis","volume":"8","author":"Pita-Gutierrez","year":"2013","journal-title":"PloS One"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1007\/s11102-015-0677-y","article-title":"The effects of somatostatin analogue therapy on pituitary tumor volume in patients with acromegaly","volume":"19","author":"Colao","year":"2016","journal-title":"Pituitary"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.4158\/ep14575.dscr","article-title":"American association of clinical endocrinologists and american college of endocrinology disease state clinical review: management of acromegaly patients: what is the role of pre-operative medical therapy","volume":"21","author":"Fleseriu","year":"2015","journal-title":"Endocr Pract"},{"key":"B20","doi-asserted-by":"publisher","first-page":"14","DOI":"10.1111\/cen.14790","article-title":"Preoperative medical treatments and surgical approaches for acromegaly: A systematic review","volume":"98","author":"Papaioannou","year":"2023","journal-title":"Clin Endocrinol (Oxf)"},{"key":"B21","doi-asserted-by":"publisher","first-page":"14070","DOI":"10.1038\/s41598-019-50639-6","article-title":"Preoperative somatostatin analogues in patients with newly diagnosed acromegaly: A systematic review and meta-analysis of comparative studies","volume":"9","author":"Yang","year":"2019","journal-title":"Sci Rep"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2010-0670","article-title":"Approach to the patient with persistent acromegaly after pituitary surgery","volume":"95","author":"Katznelson","year":"2010","journal-title":"J Clin Endocrinol Metab"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.1007\/s11102-019-01012-3","article-title":"Diagnosis, treatment and follow-up of patients with acromegaly in a clinical practice setting in Spain: the ACROPRAXIS program Delphi survey","volume":"23","author":"de Pablos-Velasco","year":"2020","journal-title":"Pituitary"},{"key":"B24","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1007\/s11102-023-01360-1","article-title":"Consensus on criteria for acromegaly diagnosis and remission","volume":"27","author":"Giustina","year":"2024","journal-title":"Pituitary"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2021.648411","article-title":"Pasireotide in the personalized treatment of acromegaly","volume":"12","author":"Puig-Domingo","year":"2021","journal-title":"Front Endocrinol (Lausanne)"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.1016\/j.eprac.2021.12.017","article-title":"Personalized medical treatment of patients with acromegaly: a review","volume":"28","author":"Lim","year":"2022","journal-title":"Endocr Pract"},{"key":"B27","doi-asserted-by":"publisher","first-page":"48","DOI":"10.1016\/j.arcmed.2011.01.004","article-title":"Efficacy and safety of radiotherapy in acromegaly","volume":"42","author":"Gonz\u00e1lez","year":"2011","journal-title":"Arch Med Res"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.1016\/j.mayocp.2021.11.007","article-title":"Diagnosis and treatment of acromegaly: an update","volume":"97","author":"Ershadinia","year":"2022","journal-title":"Mayo Clin Proc"}],"container-title":["Frontiers in Endocrinology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2025.1593959\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,6,12]],"date-time":"2025-06-12T04:10:54Z","timestamp":1749701454000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2025.1593959\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,12]]},"references-count":28,"alternative-id":["10.3389\/fendo.2025.1593959"],"URL":"https:\/\/doi.org\/10.3389\/fendo.2025.1593959","relation":{},"ISSN":["1664-2392"],"issn-type":[{"value":"1664-2392","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,12]]},"article-number":"1593959"}}