title: Treatment of persistent and recurrent acromegaly.
abstract: Acromegaly is a chronic insidious disease characterised by growth hormone (GH) hypersecretion, typically from a pituitary adenoma. Effective treatment of acromegaly is vital because it is associated with a mortality rate more than twice that of the general population, an increased prevalence of colonic malignancy and many significant co-morbidities. Transsphenoidal adenoma resection is still the best first-line treatment for acromegaly but persistence (43%) or recurrence (2% to 3%) of GH hypersecretion after surgery remains a problem. Treatment options for acromegaly after failed initial therapy or recurrence include further surgery, radiotherapy, radiosurgery or medical therapies, including somatostatin analogues, dopamine agonists and growth hormone receptor antagonists. There has been a progressive lowering of the accepted GH level defining cure in acromegaly. This article reviews the efficacy and safety of the various treatment options for persistent or recurrent acromegaly and the changing definition of cure.
authors.affiliation: Department of Neurosurgery, The Royal Melbourne Hospital, Grattan Street, Parkville 3050, Victoria, Australia. lanadelporto@hotmail.com
authors.forename: Lana A
authors.initials: LA
authors.lastname: Del Porto
authors.forename: Simon V
authors.initials: SV
authors.lastname: Liubinas
authors.forename: Andrew H
authors.initials: AH
authors.lastname: Kaye
mesh_terms: D000172:Acromegaly / Q000378:metabolism / Q000503:physiopathology / Q000628:therapy*; D000236:Adenoma / Q000175:diagnosis / Q000378:metabolism / Q000628:therapy*; D003131:Combined Modality Therapy / Q000379:methods; D049912:Growth Hormone-Secreting Pituitary Adenoma / Q000175:diagnosis / Q000378:metabolism / Q000628:therapy*; D006801:Humans; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000517:prevention & control / Q000628:therapy*; D019635:Neurosurgical Procedures / Q000379:methods / Q000592:standards; D012008:Recurrence