Abstract
Acromegaly is an insidious disease that, in most cases, is a result of a pituitary adenoma that hypersecretes growth hormone (GH). The goals of therapy are to control excess GH secretion and limit, if not reverse, the long-term medical consequences and risk of premature mortality associated with acromegaly. Surgery is currently the preferred primary therapeutic option because it can lead to rapid reductions in GH levels and prevent mass effects from local tumor growth. Medical therapy is used most often in an adjuvant, secondary role for patients in whom surgery has been unsuccessful. Radiation therapy is most commonly recommended in the setting of failed surgery and lack of adequate control with medical therapy. A role of primary medical therapy for patients de novo has been proposed, particularly with regard to somatostatin analogues. These analogues may control GH levels and reduce tumor volume in up to 50% of subjects, suggesting that they may be efficacious in this context. The use of somatostatin analogues to improve surgical outcome has also been proposed, but there is a lack of randomized trials available to address this issue. Primary medical therapy is well tolerated and further studies are necessary to identify patients who should be targeted for such therapy.
Key Points
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The goal of therapy for acromegaly is to control both growth-hormone hypersecretion and tumor size; this leads to reversal of, or improvement in, the long-term morbidity and mortality associated with this disease
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Medical therapy is largely relegated to an adjuvant role for patients who have active disease following surgical intervention
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Medical therapy, especially with somatostatin analogues, has been proposed as primary, de novo therapy for acromegaly, in lieu of surgery
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As discussed in this review, somatostatin analogues can be effective as primary medical therapy
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Katznelson, L. Drug Insight: primary medical therapy of acromegaly. Nat Rev Endocrinol 2, 109–117 (2006). https://doi.org/10.1038/ncpendmet0096
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DOI: https://doi.org/10.1038/ncpendmet0096
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