title: The role of primary pharmacological therapy in acromegaly.
abstract: OBJECTIVE
  Primary pharmacological therapy may be the only viable treatment option for many patients with acromegaly, especially those presenting with advanced disease with large inoperable tumors. Long-acting somatostatin analogs are currently the first-line treatment of choice in this setting, where they provide biochemical control and reduce tumor size in a significant proportion of patients. We herein present a brief overview of the role of primary pharmacological therapy in the treatment of acromegaly within the context of Latin America and support this with a representative case study.
  
  
  METHODS
  A 20 year old male presented with clinical and biochemical evidence of acromegaly. The glucose-suppressed growth hormone (GH) was 5.3 μg/L, his insulin-like growth factor-1(IGF-1) was 3.5 times the ULN and serum prolactin greater than 4,000 μg/L. Pituitary MRI revealed a large and invasive mass, extending superiorly into the optic chiasm and laterally into the left cavernous sinus. He was treated with a combination of octreotide and cabergoline with remarkable clinical improvement, normalization of GH and IGF-1 values and striking shrinkage of the adenoma.
  
  
  CONCLUSIONS
  This case illustrates how effective the pharmacological therapy of acromegaly can be and yet at the same time, raises several important issues such as the need for life-long treatment with costly medications such as the somatostatin analogs. Access to these agents may be limited in regions where resources are restricted and clinicians face challenges in order to make the most efficient use of available options.
authors.affiliation: Servicio de Endocrinología, Hospital de Especialidades, Centro Médico Nacional S.XXI, IMSS, Mexico City, Mexico.
authors.forename: Ana Laura
authors.initials: AL
authors.lastname: Espinosa de los Monteros
authors.forename: Carmen A
authors.initials: CA
authors.lastname: Carrasco
authors.forename: Alfredo Adolfo Reza
authors.initials: AA
authors.lastname: Albarrán
authors.forename: Mônica
authors.initials: M
authors.lastname: Gadelha
authors.forename: Alin
authors.initials: A
authors.lastname: Abreu
authors.forename: Moisés
authors.initials: M
authors.lastname: Mercado
mesh_terms: D000172:Acromegaly / Q000188:drug therapy*; D000236:Adenoma / Q000188:drug therapy* / Q000473:pathology; D000077465:Cabergoline; D018491:Dopamine Agonists / Q000627:therapeutic use; D004873:Ergolines / Q000627:therapeutic use*; D019382:Human Growth Hormone / Q000031:analogs & derivatives / Q000191:economics / Q000627:therapeutic use; D006801:Humans; D008297:Male; D015282:Octreotide / Q000627:therapeutic use*; D010911:Pituitary Neoplasms / Q000188:drug therapy* / Q000473:pathology; D013004:Somatostatin / Q000031:analogs & derivatives / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D018491:Dopamine Agonists; D004873:Ergolines; D019382:Human Growth Hormone; D013004:Somatostatin; D000077465:Cabergoline; C406545:pegvisomant; D015282:Octreotide