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.