Current status and future opportunities for controlling acromegaly.

2.50
Hdl Handle:
http://hdl.handle.net/10541/82056
Title:
Current status and future opportunities for controlling acromegaly.
Authors:
Melmed, Shlomo; Vance, Mary Lee; Barkan, Ariel L; Bengtsson, B A; Kleinberg, David L; Klibanski, Anne; Trainer, Peter J
Abstract:
Growth-hormone (GH) secreting adenomas, including acromegaly, account for approximately one-sixth of all pituitary adenomas and are associated with mortality rates at least twice that of the general population. The ultimate goal of therapy for acromegaly is normalization of morbidity and mortality rates achieved through removal or reduction of the tumor mass and normalization of insulin-like growth factor I (IGF-I) levels. Previously published efficacy results of current treatment modalities (surgery, conventional radiation, and medical therapy with dopamine agonists and somatostatin analogs) are often difficult to compare because of the different criteria used to define cure (some of which are now considered inadequate). For each of these modalities, pooled data from a series of acromegaly studies were reviewed for rates of IGF-I normalization, a currently accepted definition of cure. The results showed overall cure rates of approximately 10% for bromocriptine, 34% for cabergoline, 36% for conventional radiation, 50-90% for surgery for microadenomas and less than 50% for macroadenomas, and 54-66% for octreotide. These cure rates based on IGF-I normalization are generally less than those reported for cure based solely on GH levels. Novel new therapies for acromegaly include the somatostatin analog, lanreotide, Gamma Knife radiosurgery, and pegvisomant, the first in its class of new GH receptor antagonists. Although it does not appear that Gamma Knife radiosurgery results in significantly higher cure rates or fewer complications, it does provide a notable improvement in delivery compared with conventional radiation. Early studies have reported IGF-I normalization in 48% of lanreotide-treated patients and up to 97% of pegvisomant-treated.
Affiliation:
Division of Endocrinology and Metabolism, Ceder-Sinai Medical Center, Los Angeles, CA 90048, USA. shlomo.melmed@cshs.org
Citation:
Current status and future opportunities for controlling acromegaly. 2002, 5 (3):185-96 Pituitary
Journal:
Pituitary
Issue Date:
2002
URI:
http://hdl.handle.net/10541/82056
DOI:
10.1023/A:1023369317275
PubMed ID:
12812311
Language:
en
ISSN:
1386-341X
Appears in Collections:
All Christie Publications

Full metadata record

DC FieldValue Language
dc.contributor.authorMelmed, Shlomo-
dc.contributor.authorVance, Mary Lee-
dc.contributor.authorBarkan, Ariel L-
dc.contributor.authorBengtsson, B A-
dc.contributor.authorKleinberg, David L-
dc.contributor.authorKlibanski, Anne-
dc.contributor.authorTrainer, Peter J-
dc.date.accessioned2009-09-22T11:35:09Z-
dc.date.available2009-09-22T11:35:09Z-
dc.date.issued2002-
dc.identifier.citationCurrent status and future opportunities for controlling acromegaly. 2002, 5 (3):185-96 Pituitaryen
dc.identifier.issn1386-341X-
dc.identifier.pmid12812311-
dc.identifier.doi10.1023/A:1023369317275-
dc.identifier.urihttp://hdl.handle.net/10541/82056-
dc.description.abstractGrowth-hormone (GH) secreting adenomas, including acromegaly, account for approximately one-sixth of all pituitary adenomas and are associated with mortality rates at least twice that of the general population. The ultimate goal of therapy for acromegaly is normalization of morbidity and mortality rates achieved through removal or reduction of the tumor mass and normalization of insulin-like growth factor I (IGF-I) levels. Previously published efficacy results of current treatment modalities (surgery, conventional radiation, and medical therapy with dopamine agonists and somatostatin analogs) are often difficult to compare because of the different criteria used to define cure (some of which are now considered inadequate). For each of these modalities, pooled data from a series of acromegaly studies were reviewed for rates of IGF-I normalization, a currently accepted definition of cure. The results showed overall cure rates of approximately 10% for bromocriptine, 34% for cabergoline, 36% for conventional radiation, 50-90% for surgery for microadenomas and less than 50% for macroadenomas, and 54-66% for octreotide. These cure rates based on IGF-I normalization are generally less than those reported for cure based solely on GH levels. Novel new therapies for acromegaly include the somatostatin analog, lanreotide, Gamma Knife radiosurgery, and pegvisomant, the first in its class of new GH receptor antagonists. Although it does not appear that Gamma Knife radiosurgery results in significantly higher cure rates or fewer complications, it does provide a notable improvement in delivery compared with conventional radiation. Early studies have reported IGF-I normalization in 48% of lanreotide-treated patients and up to 97% of pegvisomant-treated.en
dc.language.isoenen
dc.subjectPituitary Canceren
dc.subject.meshAcromegaly-
dc.subject.meshAdenoma-
dc.subject.meshHumans-
dc.subject.meshPituitary Neoplasms-
dc.titleCurrent status and future opportunities for controlling acromegaly.en
dc.contributor.departmentDivision of Endocrinology and Metabolism, Ceder-Sinai Medical Center, Los Angeles, CA 90048, USA. shlomo.melmed@cshs.orgen
dc.identifier.journalPituitaryen

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