European Journal of Endocrinology

The takeaway from the authors is that this combination can offer durable control for really hard-to-treat cases, but that blood sugar needs to be watched closely since pegvizumab doesn't seem to offset that side effect.

Next, a systematic review in the European Journal of Endocrinology looked at dietary interventions and vitamin D across pituitary tumors generally, including acromegaly.

The standout finding for our purposes is that a very low-carbohydrate ketogenic-style diet was associated with lower IGF-1 levels in acromegaly patients, and that replacing vitamin D3 was linked to a lower risk of vertebral fractures.

The evidence base here is small, just a handful of studies, so this isn't practice-changing yet, but it's a signal that diet and vitamin D status might be useful levers alongside standard treatment.

This week's papers tell almost one continuous story, and it's about the heart.

The biggest piece is a nationwide cohort study out of Finland published in the European Journal of Endocrinology that followed more than 500 people with acromegaly and over 5,000 matched control patients, tracking them from 10 years before their diagnosis all the way out past 30 years afterward.

That's an enormous window, and it let the researchers pin down not just that cardiovascular disease is more common in acromegaly, but roughly when it tends to show up relative to diagnosis and how much treatment choices, pituitary hormone deficiencies, and how well-controlled the disease is all shift that risk.

It's the kind of long patient data set that's genuinely hard to build, and it gives clinicians a much sharper picture for counseling patients about heart monitoring over the long haul.

But it's a good one, so let's spend some time with it.

Published in the European Journal of Endocrinology, a team led by Gerardo Mazziotti takes on a problem that doesn't get talked about enough, the bone and joint disease that shows up in acromegaly patients.

Traditionally, doctors have treated this as two separate issues, bone fragility on one hand and joint disease or arthropathy on the other.

This review argues that's the wrong way to think about it.