The role of pegvisomant in the treatment of acromegaly.
BACKGROUND
Expert surgery in acromegaly is curative in about only 60% of cases. Postsurgical radiation therapy is associated with a high incidence of hypopituitarism and its effect on growth hormone decrease is slow. Therefore, effective adjuvant medical treatment is mandatory.


OBJECTIVE
To delineate the role of pegvisomant in the treatment of acromegaly.


METHODS
A search of the Medline, Embase and Web of Science databases for clinical studies on pegvisomant was performed. In addition, abstracts of the major endocrine society meetings in 2007 were searched.


RESULTS
When treatment with somatostatin analogues after non-curative surgery does not lead to normalisation of serum IGF-I and growth hormone concentrations, pegvisomant alone or in combination with somatostatin analogues can control disease in a substantial number of patients. The most important side effects are disturbed liver function tests and, rarely, growth of the adenoma. The efficacy in non-operated patients and the long-term safety have yet to be ascertained.
Roelfsema
Ferdinand
F
Leiden University Medical Center, Department of Endocrinology and Metabolism, Albinusdreef 2, 2333 ZA Leiden, The Netherlands. f.roelfsema@lumc.nl
Biermasz
Nienke R
NR
Pereira
Alberto M
AM
Romijn
Johannes A
JA
D000172:Acromegaly / Q000188:drug therapy*; D002986:Clinical Trials as Topic; D019382:Human Growth Hormone / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000494:pharmacology / Q000627:therapeutic use; D006801:Humans; D011986:Receptors, Somatotropin / Q000037:antagonists & inhibitors
D011986:Receptors, Somatotropin; D019382:Human Growth Hormone; C406545:pegvisomant