New therapeutic options for acromegaly.
Acromegaly is a slowly developing disfiguring disease characterized by chronic growth hormone (GH) and insulin-like growth factor-I (IGF-I) excess and caused by a pituitary somatotroph adenoma. It is associated to 2- to 3 fold increased mortality, compared to normal population, mostly due to cardiovascular and cerebro-vascular diseases, and to several co-morbid systemic illnesses, such as diabetes mellitus, hypertension, severe arthropathies, a specific cardio-myopathy, goitre, sleep-apnoea, intractable headache. The morbidity and excess mortality of acromegaly are usually the consequence of the metabolic actions of excess GH and IGF-I secretion, while only in rare patients mortality is due to the mass effects of the pituitary tumour. Since, serum IGF-I concentrations within age-adjusted normal range, and a tight GH control have to be achieved to normalize life-expectancy in these patients, an aggressive, and often multi-modality treatment is required for acromegaly. In recent years, new drugs, and new formulations of old drugs, have been developed that are able to effectively inhibit GH secretion or GH action, and may represent important adjuncts or even alternatives to the traditional approaches of surgery and radiotherapy. This review briefly summarizes the therapeutic options nowadays available for acromegaly. A brief note about innovative drugs under study, is also given.
Arosio
M
M
Institute of Endocrine Sciences, University of Milan, Ospedale Maggiore IRCCS, Milan, Italy. maura.arosio@unimi.it
Ronchi
C L
CL
Epaminonda
P
P
di Lembo
S
S
Adda
G
G
D000172:Acromegaly / Q000097:blood / Q000209:etiology*; D000236:Adenoma / Q000150:complications / Q000188:drug therapy / Q000378:metabolism / Q000601:surgery / Q000628:therapy*; D002352:Carrier Proteins / Q000037:antagonists & inhibitors; D018491:Dopamine Agonists / Q000627:therapeutic use; D019382:Human Growth Hormone / Q000031:analogs & derivatives* / Q000097:blood / Q000627:therapeutic use; D006801:Humans; D007334:Insulin-Like Growth Factor I / Q000378:metabolism; D010911:Pituitary Neoplasms / Q000150:complications / Q000188:drug therapy / Q000378:metabolism / Q000601:surgery / Q000628:therapy*
D002352:Carrier Proteins; D018491:Dopamine Agonists; D019382:Human Growth Hormone; D007334:Insulin-Like Growth Factor I; C406545:pegvisomant; C051815:somatotropin-binding protein