Current thinking on the management of the acromegalic patient.
OBJECTIVE
Although the concept that acromegaly is associated with heightened cardiovascular risk is not new, it has become apparent that there are a number of risk factors associated with this disease and that specific therapeutic modalities may have variable effects on these risk factors. In addition, it is important to understand the medical therapies available for acromegaly and their role in acromegaly management.


RESULTS
Acromegaly is associated with heightened cardiovascular risk, including derangements in glucose homeostasis and lipids, but also in markers of vascular function. Recent studies have demonstrated treatment-specific effects on these markers. In addition, recent studies have detailed further the efficacy and safety of various therapeutic options, in particular that of pegvisomant, the growth hormone receptor antagonist. A role for medical therapy as primary, de-novo therapy has been considered and recent studies support such use.


CONCLUSIONS
The goals of acromegaly therapy are to control excess growth hormone secretion and limit, if not reverse, the long-term medical consequences and risk of premature mortality associated with acromegaly. It is critical to control both the growth hormone hypersecretion and associated cardiovascular risk factors to prevent the associated risks of cardiovascular disease and enhanced mortality. Medical therapy has an important adjuvant role in the management of acromegaly and use of somatostatin analogs as first-line therapy for specific groups of patients should be considered.
Katznelson
Laurence
L
Stanford University School of Medicine, Stanford, California 94305-5826, USA. LKatznelson@stanford.edu
D000172:Acromegaly / Q000150:complications / Q000401:mortality / Q000628:therapy*; D018491:Dopamine Agonists / Q000627:therapeutic use; D006728:Hormones / Q000627:therapeutic use; D006801:Humans; D011986:Receptors, Somatotropin / Q000037:antagonists & inhibitors; D013004:Somatostatin / Q000031:analogs & derivatives / Q000627:therapeutic use
D018491:Dopamine Agonists; D006728:Hormones; D011986:Receptors, Somatotropin; D013004:Somatostatin