Medical Therapy in Acromegaly

Overview

Journal Nat Rev Endocrinol

Specialty Endocrinology

Date 2011 Mar 31

PMID 21448141

Citations 26

Authors

Mark Sherlock

Conor Woods

Michael C Sheppard

Affiliations

Soon will be listed here.

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.

Citing Articles

MPOWERED Trial Open-Label Extension: Long-term Efficacy and Safety Data for Oral Octreotide Capsules in Acromegaly.

Fleseriu M, Molitch M, Dreval A, Pokramovich Y, Bondar I, Poteshkin Y J Clin Endocrinol Metab. 2023; 108(12):3214-3222.

PMID: 37319438 PMC: 10655542. DOI: 10.1210/clinem/dgad365.

Surgery for acromegaly: Indications and goals.

Bray D, Mannam S, Rindler R, Quillin J, Oyesiku N Front Endocrinol (Lausanne). 2022; 13:924589.

PMID: 35992136 PMC: 9386525. DOI: 10.3389/fendo.2022.924589.

Treatment of acromegaly by rosiglitazone via upregulating 15-PGDH in both pituitary adenoma and liver.

Zhang Y, Wang M, Ji C, Chen Z, Yang H, Wang L iScience. 2021; 24(9):102983.

PMID: 34485865 PMC: 8403734. DOI: 10.1016/j.isci.2021.102983.

Effectiveness of lanreotide autogel 120 mg at extended dosing intervals for acromegaly.

Bernabeu I, Fajardo C, Marazuela M, Cordido F, Venegas E, de Pablos-Velasco P Endocrine. 2020; 70(3):575-583.

PMID: 32725444 PMC: 7674328. DOI: 10.1007/s12020-020-02424-z.

Targeting growth hormone function: strategies and therapeutic applications.

Lu M, Flanagan J, Langley R, Hay M, Perry J Signal Transduct Target Ther. 2019; 4:3.

PMID: 30775002 PMC: 6367471. DOI: 10.1038/s41392-019-0036-y.

References

Plockinger U, Reichel M, Fett U, Saeger W, Quabbe H . Preoperative octreotide treatment of growth hormone-secreting and clinically nonfunctioning pituitary macroadenomas: effect on tumor volume and lack of correlation with immunohistochemistry and somatostatin receptor scintigraphy. J Clin Endocrinol Metab. 1994; 79(5):1416-23. DOI: 10.1210/jcem.79.5.7962337. View

Sherlock M, Fernandez-Rodriguez E, Alonso A, Reulen R, Ayuk J, Clayton R . Medical therapy in patients with acromegaly: predictors of response and comparison of efficacy of dopamine agonists and somatostatin analogues. J Clin Endocrinol Metab. 2009; 94(4):1255-63. DOI: 10.1210/jc.2008-1420. View

Steffin B, Gutt B, Bidlingmaier M, Dieterle C, Oltmann F, Schopohl J . Effects of the long-acting somatostatin analogue Lanreotide Autogel on glucose tolerance and insulin resistance in acromegaly. Eur J Endocrinol. 2006; 155(1):73-8. DOI: 10.1530/eje.1.02185. View

Melmed S, Colao A, Barkan A, Molitch M, Grossman A, Kleinberg D . Guidelines for acromegaly management: an update. J Clin Endocrinol Metab. 2009; 94(5):1509-17. DOI: 10.1210/jc.2008-2421. View

Neggers S, van Aken M, Janssen J, Feelders R, de Herder W, van der Lely A . Long-term efficacy and safety of combined treatment of somatostatin analogs and pegvisomant in acromegaly. J Clin Endocrinol Metab. 2007; 92(12):4598-601. DOI: 10.1210/jc.2007-1234. View

Morange I, De Boisvilliers F, Chanson P, Lucas B, Dewailly D, Catus F . Slow release lanreotide treatment in acromegalic patients previously normalized by octreotide. J Clin Endocrinol Metab. 1994; 79(1):145-51. DOI: 10.1210/jcem.79.1.8027218. View

Livadas S, Hadjidakis D, Argyropoulou M, Stamatelatou M, Kelekis D, Raptis S . Disappearance of a growth hormone secreting macro adenoma during long-term somatostatin analogue administration and recurrence following somatostatin withdrawal. Hormones (Athens). 2006; 5(1):57-63. DOI: 10.14310/horm.2002.11169. View

Trainer P, Drake W, Katznelson L, Freda P, Lely A, Dimaraki E . Treatment of acromegaly with the growth hormone-receptor antagonist pegvisomant. N Engl J Med. 2000; 342(16):1171-7. DOI: 10.1056/NEJM200004203421604. View

Cozzi R, Attanasio R, Lodrini S, Lasio G . Cabergoline addition to depot somatostatin analogues in resistant acromegalic patients: efficacy and lack of predictive value of prolactin status. Clin Endocrinol (Oxf). 2004; 61(2):209-15. DOI: 10.1111/j.1365-2265.2004.02082.x. View

10.

Ben-Shlomo A, Melmed S . Pituitary somatostatin receptor signaling. Trends Endocrinol Metab. 2010; 21(3):123-33. PMC: 2834886. DOI: 10.1016/j.tem.2009.12.003. View

11.

Lancranjan I, Atkinson A . Results of a European multicentre study with Sandostatin LAR in acromegalic patients. Sandostatin LAR Group. Pituitary. 2000; 1(2):105-14. DOI: 10.1023/a:1009980404404. View

12.

Bevan J . Clinical review: The antitumoral effects of somatostatin analog therapy in acromegaly. J Clin Endocrinol Metab. 2004; 90(3):1856-63. DOI: 10.1210/jc.2004-1093. View

13.

Freda P, Katznelson L, van der Lely A, Reyes C, Zhao S, Rabinowitz D . Long-acting somatostatin analog therapy of acromegaly: a meta-analysis. J Clin Endocrinol Metab. 2005; 90(8):4465-73. DOI: 10.1210/jc.2005-0260. View

14.

Jaffe C, Barkan A . Treatment of acromegaly with dopamine agonists. Endocrinol Metab Clin North Am. 1992; 21(3):713-35. View

15.

Wakil A, Rigby A, Clark A, Kallvikbacka-Bennett A, Atkin S . Low dose cabergoline for hyperprolactinaemia is not associated with clinically significant valvular heart disease. Eur J Endocrinol. 2008; 159(4):R11-4. DOI: 10.1530/EJE-08-0365. View

16.

Baldelli R, Battista C, Leonetti F, Ghiggi M, Ribaudo M, Paoloni A . Glucose homeostasis in acromegaly: effects of long-acting somatostatin analogues treatment. Clin Endocrinol (Oxf). 2003; 59(4):492-9. DOI: 10.1046/j.1365-2265.2003.01876.x. View

17.

Gillis J, Noble S, Goa K . Octreotide long-acting release (LAR). A review of its pharmacological properties and therapeutic use in the management of acromegaly. Drugs. 1997; 53(4):681-99. DOI: 10.2165/00003495-199753040-00009. View

18.

Wright A, Hill D, Lowy C, Fraser T . Mortality in acromegaly. Q J Med. 1970; 39(153):1-16. View

19.

Buhk J, Jung S, Nikos Psychogios M, Goricke S, Hartz S, Schulz-Heise S . Tumor volume of growth hormone-secreting pituitary adenomas during treatment with pegvisomant: a prospective multicenter study. J Clin Endocrinol Metab. 2009; 95(2):552-8. DOI: 10.1210/jc.2009-1239. View

20.

Petersenn S, Schopohl J, Barkan A, Mohideen P, Colao A, Abs R . Pasireotide (SOM230) demonstrates efficacy and safety in patients with acromegaly: a randomized, multicenter, phase II trial. J Clin Endocrinol Metab. 2010; 95(6):2781-9. DOI: 10.1210/jc.2009-2272. View