title: Daily life reflections of acromegaly guidelines.
abstract: OBJECTIVE
  To determine the differences in acromegaly diagnosis, treatment, and follow-up among Turkish endocrinologists, and to investigate how the published guidelines are applied in clinical practice.
  
  
  METHODS
  The questionnaire was formatted as an electronic survey, conducted between November and December 2015, and sent weekly for 6 weeks via e-mail to 528 endocrinologists in Turkey.
  
  
  RESULTS
  The questionnaire was answered by 37.4 % of endocrinologists. Insulin-like growth factor-1 and nadir growth hormone level after 75 g oral glucose tolerance test (nadir GH-OGTT) were the most commonly preferred methods for the initial diagnosis. A total of 49.5 % of the participants reported using preoperative medical therapy (MT) either routinely or on a case-to-case basis. Somatostatin analogs were the most commonly used drugs, both in pre- and postoperative MT. Disease activity following surgery was assessed in the 3rd postoperative month using IGF-1 levels. Similarly, IGF-1 monitoring was preferred in the follow-up period. Monitoring nadir GH-OGTT levels was the most commonly used method in the assessment of discordant test results. The dose titration was done at month 3 after the start of MT. Resistance to SRLs was considered after using the maximal dose for at least 6 months. Pegvisomant was generally used in second- and third-line therapy. Similarly, cabergoline was not preferred in monotherapy by the majority of participants. Radiotherapy was considered in patients with incomplete response to surgery and medical treatments.
  
  
  CONCLUSIONS
  Although there were subtle differences, clinical practice guidelines were usually followed among Turkish endocrinologists.
authors.affiliation: Department of Internal Medicine, Cerrahpasa Medical School, University of Istanbul, Istanbul, Turkey.
authors.forename: T
authors.initials: T
authors.lastname: Apaydin
authors.affiliation: Department of Endocrinology and Metabolism, Cerrahpasa Medical School, University of Istanbul, 34303, Cerrahpasa, Istanbul, Turkey.
authors.forename: H M
authors.initials: HM
authors.lastname: Ozkaya
authors.affiliation: Department of Endocrinology and Metabolism, Cerrahpasa Medical School, University of Istanbul, 34303, Cerrahpasa, Istanbul, Turkey.
authors.forename: F E
authors.initials: FE
authors.lastname: Keskin
authors.affiliation: Department of Endocrinology and Metabolism, Cerrahpasa Medical School, University of Istanbul, 34303, Cerrahpasa, Istanbul, Turkey.
authors.forename: O A
authors.initials: OA
authors.lastname: Haliloglu
authors.affiliation: Department of Endocrinology and Metabolism, Cerrahpasa Medical School, University of Istanbul, 34303, Cerrahpasa, Istanbul, Turkey.
authors.forename: K
authors.initials: K
authors.lastname: Karababa
authors.affiliation: Pituitary Center, University of Istanbul, Istanbul, Turkey.
authors.forename: S
authors.initials: S
authors.lastname: Erdem
authors.affiliation: Department of Endocrinology and Metabolism, Cerrahpasa Medical School, University of Istanbul, 34303, Cerrahpasa, Istanbul, Turkey. kadioglup@yahoo.com.|Pituitary Center, University of Istanbul, Istanbul, Turkey. kadioglup@yahoo.com.
authors.forename: P
authors.initials: P
authors.lastname: Kadioglu
mesh_terms: D000172:Acromegaly / Q000175:diagnosis / Q000628:therapy*; D000203:Activities of Daily Living; D004704:Endocrinology; D006801:Humans; D017410:Practice Guidelines as Topic / Q000592:standards*; D010818:Practice Patterns, Physicians' / Q000592:standards*
keywords: Acromegaly; Daily life practice; Growth hormone; Insulin-like growth factor 1; Questionnaire