Optimizing acromegaly treatment.
Acromegaly is a rare chronic and disabling disease with many comorbidities leading to a mortality rate three times higher than in the normal population, mainly due to cardiovascular diseases. Based on epidemiological evidence, the mortality rate is normalized to normal population values when treatment brings serum GH levels to <2.5 microg/l and IGF-1 levels to normal age/gender values. Many efficacious therapeutic approaches are currently available to acromegaly control, namely pituitary surgery, radiotherapy and medical therapy, which encompasses dopamine agonists (DA), somatostatin analogs (SA; currently considered the gold standard treatment) and the GH-receptor antagonist pegvisomant (PEG-V). The efficacy and indications of each therapy depend on the tumor size and invasiveness, patient's condition and the local availability of each treatment modality. Treatment with SA analogs controls about two thirds of acromegalics, with recent data highly suggesting that this result can be enhanced by the combination of SA with PEG-V, or with the DA cabergoline. Moreover, surgical tumor debulking, even noncurative, might overcome the resistance of GH-secreting adenomas to SA. Therefore, these strategies may optimize acromegaly control, and potentially reduce treatment costs.
Bronstein
Marcello D
MD
Neuroendocrine Unit, Division of Endocrinology and Metabolism, Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, S P, Brazil.
D000172:Acromegaly / Q000188:drug therapy*; D018491:Dopamine Agonists / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D006801:Humans; D010911:Pituitary Neoplasms / Q000601:surgery; D011986:Receptors, Somatotropin / Q000037:antagonists & inhibitors; D013004:Somatostatin / Q000031:analogs & derivatives
D018491:Dopamine Agonists; D011986:Receptors, Somatotropin; D013004:Somatostatin