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 with significant residual disease after surgery, either a somatostatin analogue or pegvisomant is recommended as the first-line medical therapy. In patients with modest residual disease, an initial trial of a dopamine agonist is appropriate, although the response to cabergoline appears to decrease with time. When patients do not respond adequately to single agents, combination therapy with two or all three of these agents may improve efficacy and reduce side effects.