[Therapeutic management of acromegaly].
BACKGROUND
Only 60% of the patients with acromegaly are biochemically cured (growth hormone [GH] nadir < 1.0 microg/l after an oral glucose load, normalized age- and gender-matched insulin-like growth factor-1 [IGF-1] levels) after transsphenoidal surgery of the pituitary gland. In the absence of a remission there are effective pharmacological treatment regimens available which are able to lower GH and IGF-1 serum levels.
Somatostatin analogs, a GH receptor antagonist and dopamine agonists have been shown to alleviate the comorbid features and to normalize GH and IGF-1 levels.


METHODS
In this overview six case reports are presented to highlight the current pharmacological treatment options and to propose an algorithm for the clinical routine in patients with persisting acromegaly.


CONCLUSIONS
Transsphenoidal surgery is the treatment of choice for the initial management of acromegaly. In the absence of a remission there are effective pharmacological treatment regimens available among which somatostatin analogs are recommended as the first-line treatment.
Metzner
Cornelia
C
Medizinische Klinik I, Endokrinologie, Diabetologie und Stoffwechsel, Ruprecht-Karls-Universität, Heidelberg.
Hadziselimovic
Senad
S
Grafe
Ingo
I
Nawroth
Peter
P
Kasperk
Christian
C
D000172:Acromegaly / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D000236:Adenoma / Q000601:surgery; D000328:Adult; D000368:Aged; D000465:Algorithms; D018491:Dopamine Agonists / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D013006:Growth Hormone / Q000097:blood; D019382:Human Growth Hormone / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000627:therapeutic use; D006801:Humans; D007334:Insulin-Like Growth Factor I / Q000032:analysis; D008297:Male; D008875:Middle Aged; D015282:Octreotide / Q000008:administration & dosage / Q000627:therapeutic use; D010911:Pituitary Neoplasms / Q000601:surgery; D011986:Receptors, Somatotropin / Q000037:antagonists & inhibitors*; D012074:Remission Induction; D013004:Somatostatin / Q000031:analogs & derivatives*
D018491:Dopamine Agonists; D011986:Receptors, Somatotropin; D019382:Human Growth Hormone; D013004:Somatostatin; D007334:Insulin-Like Growth Factor I; D013006:Growth Hormone; C406545:pegvisomant; D015282:Octreotide