AffiliationDepartment of Endocrinology, Christie Hospital NHS Trust, Manchester, UK.
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AbstractAcromegaly is a rare endocrine disorder characterized by growth hormone hypersecretion and is usually caused by a pituitary macroadenoma. It is associated with significantly increased patient morbidity and mortality. Molecular biological studies have implicated a causative role for oncogenic mutations (activating Gs alpha mutations and/or chromosomal 11q13 deletions) in less than 50% of cases. The cause(s) in the remaining 50% is speculative. Epidemiological evidence indicates that biochemical cure is achieved when mean GH levels are 5mU/l or less during a day-profile. This GH value correlates well with that required to normalize the serum IGF-1 concentration, a GH-dependent peptide which can be used to monitor the disease activity in acromegaly. Treatment must be carried out under the supervision of a dedicated endocrinologist and tailored to patients needs. The success of any treatment modality (surgery/pituitary irradiation/medical) depends on adenoma size and the extent of pretreatment GH hypersecretion. A combination of therapies is usually required to achieve satisfactory control of adenoma growth and GH hypersecretion. Octreotide, a synthetic analogue of native somatostatin, is particularly effective in controlling GH hypersecretion in this condition and the widespread introduction of a long-acting depot preparation is eagerly awaited. The development of true GH deficiency as a result of treatment is potentially worrying in view of its possible contribution to the increased incidence of cardiovascular mortality associated with hypopituitarism.
CitationAcromegaly: unravelling a complex disease. 1995, 5 (3):119-24 Growth Regul
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- Authors: Lissett CA, Peacey SR, Laing I, Tetlow L, Davis JR, Shalet SM
- Issue date: 1998 Nov
- Outcome of transsphenoidal surgery for acromegaly using strict criteria for surgical cure.
- Authors: Sheaves R, Jenkins P, Blackburn P, Huneidi AH, Afshar F, Medbak S, Grossman AB, Besser GM, Wass JA
- Issue date: 1996 Oct
- The Birmingham pituitary database: auditing the outcome of the treatment of acromegaly.
- Authors: Jenkins D, O'Brien I, Johnson A, Shakespear R, Sheppard MC, Stewart PM
- Issue date: 1995 Nov
- Presurgical octreotide treatment in acromegaly: no improvement of final growth hormone (GH) concentration and pituitary function. A long-term case-control study.
- Authors: Plöckinger U, Quabbe HJ
- Issue date: 2005 May
- Sandostatin LAR in acromegaly: a 6-week injection interval suppresses GH secretion as effectively as a 4-week interval.
- Authors: Biermasz NR, van den Oever NC, Frölich M, Arias AM, Smit JW, Romijn JA, Roelfsema F
- Issue date: 2003 Mar