Therapeutic Goals of Acromegaly

The presence of benign tumors or adenomas in the anterior lobe of the pituitary gland may lead to a variety of endocrine symptoms and aberrant growth hormone (GH) secretion. Hypersecretion of GH in response to an adenoma results in acromegaly or gigantism, a condition observed in adults and associated with significant morbidity and mortality. The estimated prevalence of acromegaly in the US is approximately 15,000 people, with men and women being equally affected.

Reducing GH production to normal levels remains the primary goal for treating acromegaly. The overall therapy of acromegaly involves preserving the pituitary function and controlling the tumor mass, normalizing biochemical markers, relieving signs and symptoms, and eliminating excess mortality associated with active disease.

Traditionally, transphenoidal neurosurgery, to excise the pituitary tumors that are causing excess GH secretion, has been considered first-line treatment. However, as medical treatment options have improved, especially as somatostatin analogues have become available and been refined, researchers have started to consider the potential benefits of using first-line pharmacologic treatment in some patients with acromegaly. Whereas, dopamine agonists were considered an inferior option to neurosurgery, treatment with somatostatin analogues seems promising. In a prospective, open multi-center study, 63% of patients who received a somatostatin analogue as primary treatment achieved target GH levels <2.5 ng/mL, compared with 67% of patients who received the somatostatin analogue as adjuvant therapy after surgery. Given the fact that remnants of tumors often remain after surgery, there are numerous situations in which primary or adjuvant therapy with a somatostatin analogue may be indicated.

In this conversation, two endocrinologists, Dr. David M. Cook and Dr. Lawrence Katznelson, join Dr. Carlos Hamilton, Jr. to discuss the therapeutic goals for acromegaly.

Related References/Reading:

  1. Ayuk J, Sheppard MC. Growth hormone and its disorders. Postgrad Med J. 2006;82(963):24-30.
  2. Cook DM, Ezzat S, Katznelson L, et al. American Association of Clinical Endocrinologists Medical Guidelines for Clinical Practice for the Diagnosis and Treatment of Acromegaly. Endocrine Practice. 2004;10: 213-225.
  3. Giustina A, Burkan A, Casanueva FF, et al. Criteria for cure of acromegaly: a consensus statement. J Endocrinol Metab. 2000;85:526-29.
  4. Katznelson L. Current thinking on the management of the acromegalic patient. Curr Opin Endocrinol Diabetes Obes. 2007;14(4):311-6.
  5. Katznelson L. Diagnosis and treatment of acromegaly. Growth Horm IGF Res. 2005;15 Suppl A:S31-5.
  6. Melmed, S. Medical Process: Acromegaly. N Engl J Med. 2006;355:2558-2573.
  7. Tiu SC, Ng CM, Shek, Chi CS et al. Multiple morbidities in acromegaly with apparently normal growth hormone levels. Endocrinologist. 2007;17:175-178.
  8. Tzanela M. Dynamic tests and basal values for defining active acromegaly. Neuroendocrinology. 2006;83(3-4):200-4.