Medical management of growth hormone-secreting pituitary adenomas.
The primary treatment of acromegaly remains transsphenoidal adenomectomy, yet the tissue overgrowth of acromegaly often progresses following surgery, and responds to radiotherapy only after significant delay. Persistently elevated serum growth hormone (GH) and insulin-like growth factor-I (IGF-I) concentrations can be normalized in about half of post-surgery acromegalics using the pharmacologic alternatives presently available, the dopamine agonists (DA) and somatostatin (SST) analogs. Cabergoline, the most efficacious DA, normalizes IGF-I in approximately 37% of patients, whereas the long-acting SST analogs, Octreotide LAR and Lanreotide SR, do so in 66%. Significant tumor shrinkage may be attained with SST analogs in particular, and when necessary, the primary medical treatment of acromegaly may be successfully addressed with this class of drugs. Greatly enhanced efficacy is expected from the GH receptor antagonist pegvisomant, which is nearing market availability and will enable the normalization of serum IGF-I in virtually all patients treated. We review here the pharmacologic treatments of excessive GH secretion.
Racine
Michael S
MS
Division of Endocrinology and Metabolism, University of Michigan Medical Center, 3920 Taubman Center, Box 0354, Ann Arbor, Michigan 48109-0354, USA.
Barkan
Ariel L
AL
D000236:Adenoma / Q000188:drug therapy* / Q000378:metabolism*; D018491:Dopamine Agonists / Q000627:therapeutic use; D004967:Estrogens / Q000627:therapeutic use; D019382:Human Growth Hormone / Q000378:metabolism*; D006801:Humans; D010911:Pituitary Neoplasms / Q000188:drug therapy* / Q000378:metabolism*; D011986:Receptors, Somatotropin / Q000037:antagonists & inhibitors; D013004:Somatostatin / Q000031:analogs & derivatives
D018491:Dopamine Agonists; D004967:Estrogens; D011986:Receptors, Somatotropin; D019382:Human Growth Hormone; D013004:Somatostatin