Optimizing control of acromegaly: integrating a growth hormone receptor antagonist into the treatment algorithm.

2.50
Hdl Handle:
http://hdl.handle.net/10541/79039
Title:
Optimizing control of acromegaly: integrating a growth hormone receptor antagonist into the treatment algorithm.
Authors:
Clemmons, David R; Chihara, Kazuo; Freda, Pamela U; Ho, Ken; Klibanski, Anne; Melmed, Shlomo; Shalet, Stephen M; Strasburger, Christian J; Trainer, Peter J; Thorner, Michael O
Abstract:
Acromegaly is associated with significant morbidities and a 2- to 3-fold increase in mortality because of the excessive metabolic action of GH and IGF-I, a marker of GH output. Reductions in morbidity correspond with decreases in IGF-I, and mortality is lowered following normalization of IGF-I or GH levels. Therefore, this has become an important end point. Current guidelines for the treatment of acromegaly have not considered recent advances in medical therapy, in particular, the place of pegvisomant, a GH receptor antagonist. Treatment goals include normalizing biochemical markers, controlling tumor mass, preserving pituitary function, and relieving signs and symptoms. Surgery reduces tumor volume and is considered first-line therapy. Radiation reduces tumor volume and GH and IGF-I levels, but the onset of action is slow and hypopituitarism typically develops. Therefore, pharmacotherapy is often used following surgery or as first-line therapy for nonresectable tumors. Dopamine agonists can be considered in patients exhibiting minimal disease or those with GH-prolactin-cosecreting tumors but will not achieve hormone normalization in most patients. Somatostatin analogs effectively suppress GH and IGF-I in most patients, but intolerance (e.g. diarrhea, cramping, gallstones) can occur. Pegvisomant, the newest therapeutic option, blocks GH action at peripheral receptors, normalizes IGF-I levels, reduces signs and symptoms, and corrects metabolic defects. Pegvisomant does not appear to affect tumor size and has few adverse effects. Pegvisomant is the most effective drug treatment for acromegaly in normalizing IGF-I and producing a clinical response; it is the preferred agent in patients resistant to or intolerant of somatostatin analogs.
Affiliation:
University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, USA. endo@med.unc.edu
Citation:
Optimizing control of acromegaly: integrating a growth hormone receptor antagonist into the treatment algorithm. 2003, 88 (10):4759-67 J. Clin. Endocrinol. Metab.
Journal:
The Journal of Clinical Endocrinology and Metabolism
Issue Date:
Oct-2003
URI:
http://hdl.handle.net/10541/79039
DOI:
10.1210/jc.2003-030518
PubMed ID:
14557452
Type:
Article
Language:
en
ISSN:
0021-972X
Appears in Collections:
All Christie Publications

Full metadata record

DC FieldValue Language
dc.contributor.authorClemmons, David R-
dc.contributor.authorChihara, Kazuo-
dc.contributor.authorFreda, Pamela U-
dc.contributor.authorHo, Ken-
dc.contributor.authorKlibanski, Anne-
dc.contributor.authorMelmed, Shlomo-
dc.contributor.authorShalet, Stephen M-
dc.contributor.authorStrasburger, Christian J-
dc.contributor.authorTrainer, Peter J-
dc.contributor.authorThorner, Michael O-
dc.date.accessioned2009-08-28T09:10:19Z-
dc.date.available2009-08-28T09:10:19Z-
dc.date.issued2003-10-
dc.identifier.citationOptimizing control of acromegaly: integrating a growth hormone receptor antagonist into the treatment algorithm. 2003, 88 (10):4759-67 J. Clin. Endocrinol. Metab.en
dc.identifier.issn0021-972X-
dc.identifier.pmid14557452-
dc.identifier.doi10.1210/jc.2003-030518-
dc.identifier.urihttp://hdl.handle.net/10541/79039-
dc.description.abstractAcromegaly is associated with significant morbidities and a 2- to 3-fold increase in mortality because of the excessive metabolic action of GH and IGF-I, a marker of GH output. Reductions in morbidity correspond with decreases in IGF-I, and mortality is lowered following normalization of IGF-I or GH levels. Therefore, this has become an important end point. Current guidelines for the treatment of acromegaly have not considered recent advances in medical therapy, in particular, the place of pegvisomant, a GH receptor antagonist. Treatment goals include normalizing biochemical markers, controlling tumor mass, preserving pituitary function, and relieving signs and symptoms. Surgery reduces tumor volume and is considered first-line therapy. Radiation reduces tumor volume and GH and IGF-I levels, but the onset of action is slow and hypopituitarism typically develops. Therefore, pharmacotherapy is often used following surgery or as first-line therapy for nonresectable tumors. Dopamine agonists can be considered in patients exhibiting minimal disease or those with GH-prolactin-cosecreting tumors but will not achieve hormone normalization in most patients. Somatostatin analogs effectively suppress GH and IGF-I in most patients, but intolerance (e.g. diarrhea, cramping, gallstones) can occur. Pegvisomant, the newest therapeutic option, blocks GH action at peripheral receptors, normalizes IGF-I levels, reduces signs and symptoms, and corrects metabolic defects. Pegvisomant does not appear to affect tumor size and has few adverse effects. Pegvisomant is the most effective drug treatment for acromegaly in normalizing IGF-I and producing a clinical response; it is the preferred agent in patients resistant to or intolerant of somatostatin analogs.en
dc.language.isoenen
dc.subject.meshAcromegaly-
dc.subject.meshAlgorithms-
dc.subject.meshDopamine Agonists-
dc.subject.meshGrowth Hormone-
dc.subject.meshHuman Growth Hormone-
dc.subject.meshHumans-
dc.titleOptimizing control of acromegaly: integrating a growth hormone receptor antagonist into the treatment algorithm.en
dc.typeArticleen
dc.contributor.departmentUniversity of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, USA. endo@med.unc.eduen
dc.identifier.journalThe Journal of Clinical Endocrinology and Metabolismen

Related articles on PubMed

All Items in Christie are protected by copyright, with all rights reserved, unless otherwise indicated.