Current Treatment Guidelines for Acromegaly

• Published in: The journal of clinical endocrinology and metabolism Vol. 83; no. 8; pp. 2646 - 2652
• Main Author: Melmed, S.
• Format: Journal Article
• Language: English
• Published: Bethesda, MD Endocrine Society 01.08.1998
• Subjects: Acromegaly - diagnosis; Acromegaly - drug therapy; Acromegaly - physiopathology; Acromegaly - radiotherapy; Acromegaly - surgery; Acromegaly - therapy; Adenoma - secretion; Adenoma - surgery; Biological and medical sciences; Dopamine Agonists - therapeutic use; Endocrinopathies; Human Growth Hormone - secretion; Humans; Hypothalamus. Hypophysis. Epiphysis (diseases); Medical sciences; Non tumoral diseases. Target tissue resistance. Benign neoplasms; Pituitary Neoplasms - secretion; Pituitary Neoplasms - surgery; Somatostatin - analogs & derivatives; United States; North America; America; Endocrinopathy; Human; Agonist; Pathophysiology; Bromocriptine; Diseases of the osteoarticular system; Acromegaly; Octreotide; Ergot derivatives; Radiotherapy; Antiparkinson agent; Recommendation; Chemotherapy; Pergolide; D2 Dopamine receptor; Treatment; Analog; Neurohypophyseal hormone; Pituitary diseases; Secondary effect; Somatostatin; Diagnosis; Therapeutic protocol
• ISSN: 0021-972X
• DOI: 10.1210/jc.83.8.2646

Acromegaly, an indolent disorder of growth hormone (GH) hypersecretion is most typically caused by a somatotroph cell adenoma and may be treated by several modalities. Transsphenoidal surgical resection of micro-adenomas by experienced neurosurgeons results in biochemical normalization (postglucose GH <2 ng/mL, assay-dependent, age- and sex-matched IGF-I levels) in 70% of patients. However, over 65% of GH-secreting adenomas are invasive or macroadenomas, and over 50% of these patients have persistent postoperative GH hypersecretion. Irradiation of adenomas results in attenuation of GH secretion to more than 5 ng/mL in 50% of subjects after 12 yr. However, the percent of parents who normalize IGF-I levels is less certain. Most of these patients develop associated pituitary failure and rarely develop other local adverse effects. About 60% of patients receiving somatostatin analogs achieve normalized IGF-I levels. Efficacy of medical management with somatostatin analogs may be improved by increasing injection frequency, changing delivery modes to depot preparations, and in the future, development of novel SRIF receptor subtype-specific analogs. An integrated approach to acromegaly management based upon relative risks and benefits of the currently available therapeutic modes is presented that allows for a national individualized strategy designed to achieve maximal biochemical control of GH hypersecretion and elevated IGF-I levels.