Acromegaly medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:

Overview

Patients with acromegaly are treated with somatostatin analogs like octreotide, dopamine agonists like bromocriptine, and GH receptor antagonist like pegvisomant. Radiation therapy is indicated in patients who do not respond to surgery or the medical therapy.

Medical Therapy

• Pharmacologic medical therapy is recommended among patients with persistent high growth hormone level after the surgery.
• Pharmacologic medical therapies for acromegaly include somatostatin analogs, dopamine agonists, and GH receptor antagonists.

Different treatment regimens

• 1.1.1 Somatostatin analogs:
  • Preferred regimen (1): Octreotide 50 mcg q8hr subcutaneous as initial dose and 100 mcg q8hr as effective dose.
  • Preferred regimen (2): Lanreotide 90 mg q4week for 3 months every 4 weeks subcutaneous.
  • Preferred regimen (3): Pasireotide 40 mg q4wk intramuscular.

• 1.1.2 Dopamine agonists:
  • Preferred regimen (1): Cabergoline 0.25 mg 2x/week orally.
  • Preferred regimen (2): Bromocriptine 1.25-2.5 mg qDay orally.

• 1.1.3 GH receptor antagonist:
  • Preferred regimen (1): Pegvisomant 10 mg qDay subcutaneous.

Radiation therapy

• Radiation therapy is indicated in the patients that still have an excess level of GH and IGF-1 after surgery and medical therapy. It is also indicated in patients who still have tumor remaining after surgery.
• It is recommended by the endocrine society to use the stereotactic radiotherapy (SRT) over conventional radiation in the treatment of the acromegaly.
• Follow up with the level of the GH and IGF-1 annually to determine the efficacy of the radiation in the treatment of acromegaly.