title: [Optimization of the medical treatment for acromegaly].
abstract: Somatostatin analogues are the cornerstone in the first-line and adjuvant (postsurgical) therapy in patients with acromegaly. These drugs highly effectively decrease serum concentrations of growth hormone (GH) and insulin-like growth factor type I (IGF-I), as well as pituitary adenoma size. However, in approximately one third of patients response to these agents is unsatisfactory. The optimization of the medical therapy for acromegaly can be accomplished by modifying the dose or the interval of administration of somatostatin analogues or by combining other pharmacological agents. Increasing the dose or frequency of administration is followed by an additional decrease in GH and IGF-I levels in a significant percentage of patients. These changes are not accompanied by a relevant increase in the number or severity of adverse events. Combined treatment with somatostatin analogues and pegvisomant has been shown to significantly reduce serum IGF-I levels in patients with inadequate control of disease activity. The addition of cabergoline to somatostatin analogue therapy is accompanied by a further decrease in IGF-I levels that is independent of serum prolactin concentrations.
authors.affiliation: Servicio de Endocrinología, Hospital Ramón y Cajal, Madrid, España. jdiez.hrc@salud.madrid.org
authors.forename: Juan J
authors.initials: JJ
authors.lastname: Díez
authors.forename: Pedro
authors.initials: P
authors.lastname: Iglesias
mesh_terms: D000172:Acromegaly / Q000097:blood / Q000188:drug therapy* / Q000209:etiology / Q000601:surgery; D000077465:Cabergoline; D003131:Combined Modality Therapy; D018491:Dopamine Agonists / Q000008:administration & dosage / Q000627:therapeutic use; D004304:Dosage Forms; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D004873:Ergolines / Q000008:administration & dosage / Q000627:therapeutic use; D049912:Growth Hormone-Secreting Pituitary Adenoma / Q000150:complications / Q000532:radiotherapy / Q000601:surgery; D019382:Human Growth Hormone / Q000008:administration & dosage / Q000819:agonists / Q000031:analogs & derivatives / Q000097:blood / Q000627:therapeutic use; D006801:Humans; D007334:Insulin-Like Growth Factor I / Q000032:analysis; D015282:Octreotide / Q000008:administration & dosage / Q000627:therapeutic use; D010456:Peptides, Cyclic / Q000008:administration & dosage / Q000627:therapeutic use; D010911:Pituitary Neoplasms / Q000150:complications / Q000532:radiotherapy / Q000601:surgery; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data; D011986:Receptors, Somatotropin / Q000037:antagonists & inhibitors; D013004:Somatostatin / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D018491:Dopamine Agonists; D004304:Dosage Forms; D004873:Ergolines; D010456:Peptides, Cyclic; D011986:Receptors, Somatotropin; C060347:lanreotide; D019382:Human Growth Hormone; D013004:Somatostatin; D007334:Insulin-Like Growth Factor I; D000077465:Cabergoline; C406545:pegvisomant; D015282:Octreotide