Optimizing control of acromegaly: integrating a growth hormone receptor antagonist into the treatment algorithm.
AuthorsClemmons, David R
Freda, Pamela U
Shalet, Stephen M
Strasburger, Christian J
Trainer, Peter J
Thorner, Michael O
AffiliationUniversity of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, USA. firstname.lastname@example.org
MetadataShow full item record
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.
CitationOptimizing control of acromegaly: integrating a growth hormone receptor antagonist into the treatment algorithm. 2003, 88 (10):4759-67 J. Clin. Endocrinol. Metab.
JournalThe Journal of Clinical Endocrinology and Metabolism
- How effective are current therapies for acromegaly?
- Authors: Freda PU
- Issue date: 2003 Aug
- The place of pegvisomant in the acromegaly treatment algorithm.
- Authors: Paisley AN, Trainer PJ, Drake WM
- Issue date: 2004 Jun
- Cabergoline in acromegaly.
- Authors: Kuhn E, Chanson P
- Issue date: 2017 Feb
- Pegvisomant: a growth hormone receptor antagonist used in the treatment of acromegaly.
- Authors: Tritos NA, Biller BM
- Issue date: 2017 Feb
- Acromegaly: a new therapy.
- Authors: Friend KE
- Issue date: 2002 May-Jun