Treatment strategies for acromegaly.
Acromegaly is a chronic debilitating disorder caused by a growth hormone (GH)-producing pituitary adenoma. Active acromegaly is associated with a two- to fourfold increased mortality risk, mainly from cardiovascular disease. Transsphenoidal surgery is considered as the treatment of choice because of the rapidity of cure and normalisation of survival. Secondary treatment modalities are radiotherapy and medical treatment, and are important because surgery in the best hands cures only approximately 60% in long-term studies. Medical treatment with slow-release formulations of somatostatin are now widely used, also as primary treatment, and appear to be safe and effective in 50-60% of the patients. However, no data on mortality risk with these drugs is available. Recently, a GH-receptor blocking agent, pegvisomant, was licensed for use in acromegaly and appears to normalise IGF-1 in almost all patients. This article examines the pathophysiology of acromegaly, currently used medicines and their safety and efficacy, and the new drugs that are in development.
Roelfsema
Ferdinand
F
Department of Endocrinology and Metabolic Diseases, Leiden University Medical Center, The Netherlands. f.roelfsema@lumc.nl
Biermasz
Nienke R
NR
Romijn
Johannes A
JA
Pereira
Alberto M
AM
D000172:Acromegaly / Q000188:drug therapy* / Q000453:epidemiology / Q000378:metabolism*; D000595:Amino Acid Sequence / Q000235:genetics; D002986:Clinical Trials as Topic / Q000706:statistics & numerical data / Q000639:trends; D019468:Disease Management; D015507:Drugs, Investigational / Q000737:chemistry / Q000627:therapeutic use*; D019382:Human Growth Hormone / Q000031:analogs & derivatives / Q000037:antagonists & inhibitors / Q000737:chemistry / Q000235:genetics / Q000378:metabolism / Q000627:therapeutic use; D006801:Humans; D008969:Molecular Sequence Data
D015507:Drugs, Investigational; D019382:Human Growth Hormone; C406545:pegvisomant