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  • Review Article
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Medical therapy in acromegaly

Nature Reviews Endocrinology volume 7, pages 291–300 (2011)Cite this article

Subjects

Abstract

Acromegaly is a rare disease characterized by excess secretion of growth hormone (GH) and increased circulating insulin-like growth factor 1 (IGF-1) concentrations. The disease is associated with increased morbidity and premature mortality, but these effects can be reduced if GH levels are decreased to <2.5 μg/l and IGF-1 levels are normalized. Therapy for acromegaly is targeted at decreasing GH and IGF-1 levels, ameliorating patients' symptoms and decreasing any local compressive effects of the pituitary adenoma. The therapeutic options for acromegaly include surgery, radiotherapy and medical therapies, such as dopamine agonists, somatostatin receptor ligands and the GH receptor antagonist pegvisomant. Medical therapy is currently most widely used as secondary treatment for persistent or recurrent acromegaly following noncurative surgery, although it is increasingly used as primary therapy. This Review provides an overview of current and future pharmacological therapies for patients with acromegaly.

Key Points

  • Acromegaly is associated with increased morbidity and mortality

  • Targets for therapy in acromegaly include normalization of levels of growth hormone and insulin-like growth factor 1, reduction of mortality, amelioration of symptoms and reduction in tumor volume

  • Treatment options for acromegaly include surgery, radiotherapy and medical therapies such as somatostatin receptor ligands, dopamine agonists and pegvisomant

  • Medical therapy can be used as primary or secondary therapy in acromegaly

  • Treatment with somatostatin receptor ligands (SRLs) can result in biochemical control and tumor shrinkage; long-acting SRLs are more widely used due to increased compliance and patient convenience

  • Pegvisomant treatment is associated with normalization of levels of insulin-like growth factor 1 in a large proportion of patients but does not lead to tumor shrinkage

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  1. Centre for Endocrinology Diabetes and Metabolism, University of Birmingham, Edgbaston, B15 2TT, Birmingham, UK

    Mark Sherlock, Conor Woods & Michael C. Sheppard

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M. Sherlock, C. Woods and M. C. Sheppard wrote the article, researched data for the article, provided a substantial contribution to discussion of the content and reviewed/edited the manuscript before submission.

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Sherlock, M., Woods, C. & Sheppard, M. Medical therapy in acromegaly. Nat Rev Endocrinol 7, 291–300 (2011). https://doi.org/10.1038/nrendo.2011.42

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