title: Clinical efficacy and safety results for dose escalation of somatostatin receptor ligands in patients with acromegaly: a literature review.
abstract: Acromegaly is a rare disease with a multifaceted clinical presentation. In 90-95% of patients with acromegaly, the disease is caused by a growth hormone (GH)-secreting pituitary adenoma with elevated GH levels that ultimately induce excessive hepatic secretion of insulin-like growth factor-1 (IGF-1). Somatostatin receptor ligands (SRLs) are considered the standard medical choice for the treatment of acromegaly, and normalization of GH and IGF-1 is attainable with effective therapy. This review aims to summarize the literature relative to SRL dose escalation therapy in patients with acromegaly. A United States National Library of Medicine PubMed search of SRL's was conducted using the following search terms: ((((LAR) OR ATG) OR octreotide) OR lanreotide Autogel) AND acromegaly. Related articles in non peer-reviewed journals were excluded. The rationale and benefits of SRL dose optimization therapy were investigated with emphasis on describing the clinical recognition, treatment, and management of patients with acromegaly. We found that dose escalation could provide additional biochemical control of acromegaly in patients who are inadequately controlled with conventional starting doses of octreotide LAR and lanreotide Autogel(®). Furthermore, patients should routinely have their GH and IGF-1 levels closely monitored and their SRL dose increased or decreased thereafter according to individual response.
authors.affiliation: Department of Neurological Surgery, Northwest Pituitary Center, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, (BTE 472), Portland, OR 97239, USA. fleseriu@ohsu.edu
authors.forename: Maria
authors.initials: M
authors.lastname: Fleseriu
mesh_terms: D000172:Acromegaly / Q000188:drug therapy* / Q000209:etiology; D000236:Adenoma / Q000150:complications / Q000188:drug therapy; D000465:Algorithms; D018931:Antineoplastic Agents, Hormonal / Q000008:administration & dosage* / Q000009:adverse effects*; D004305:Dose-Response Relationship, Drug; D049912:Growth Hormone-Secreting Pituitary Adenoma / Q000150:complications / Q000188:drug therapy; D006801:Humans; D008024:Ligands; D017481:Receptors, Somatostatin / Q000819:agonists*; D013004:Somatostatin / Q000031:analogs & derivatives; D016896:Treatment Outcome
chemical_list: D018931:Antineoplastic Agents, Hormonal; D008024:Ligands; D017481:Receptors, Somatostatin; D013004:Somatostatin