How to tell if one has been cured of acromegaly? Older studies defined cure as a random GH level < 5 mcg/L. More recent studies have shown that this criterion is inadequate, and more rigorous criteria have been developed as GH assays have become more sensitive. For complete control of GH secretion, patients should have …
Radiation therapy for acromegaly? Conventional radiation therapy of GH-secreting tumors causes a gradual decline in GH levels over many years, with maximal effect occurring at 10 to 15 years. Therefore, it is generally reserved as a third-line therapy for acromegaly. It may also increase the long-term risk of mortality. Stereotactic radiotherapy consists of applying a …
Mechanism of action of pegvisomant Pegvisomant is a human GH receptor antagonist that competes with endogenous GH for binding to its receptor and blocks production of IGF-1. This improves the clinical effects and metabolic defects in acromegaly. Pegvisomant controls IGF-1 levels in about two thirds of patients. It does not appear to affect tumor size …
How effective are somatostatin analogues? Somatostatin analogues markedly decrease GH levels in most patients with acromegaly, with alleviation of many of the symptoms and side effects of acromegaly. Approximately 20% to 35% of patients receiving somatostatin analogues achieve biochemical remission, although additional patients experience symptomatic improvement with partial biochemical responses. Significant tumor shrinkage occurs in …
Mechanism of action of somatostatin analogues Most GH-secreting tumors have somatostatin receptors and respond to exogenous somatostatin with decreases in GH levels. The development of long-acting somatostatin analogues (octreotide long-acting release, lanreotide autogel/depot, and pasireotide) was a major advance in the treatment of acromegaly.
What are the options for medical therapy of acromegaly? Approximately 40% to 60% of GH macroadenomas are not controlled by surgery alone, and adjuvant therapy is indicated. There are three drug classes available for the treatment of acromegaly: somatostatin analogues (octreotide, lanreotide, pasireotide); the GH receptor antagonist pegvisomant; and dopamine agonists (cabergoline, bromocriptine). In patients …
How are acromegaly or gigantism treated? Goals of therapy for GH-secreting tumors include reduction of mortality risk, tumor shrinkage, and control of GH hypersecretion. The treatment of choice for GH-secreting tumors is TSS performed by an experienced pituitary surgeon. Most patients with microadenomas are cured, and larger tumors are debulked. In experienced hands, surgical complications …