The Multimodal Treatment of Acromegaly: Current Status and Future Perspectives
Etual Espinosa, Claudia Ramirez and Moises Mercado
Affiliation: Aristoteles 68, Polanco 11560, Mexico City, Mexico.
Keywords: Acromegaly, cabergoline, dopamine agonists, GH, IGF-1, lanreotide, octreotide, pegvisomant, radiation therapy,
Acromegaly is a chronic systemic disorder caused by a GH-secreting pituitary adenoma. Active acromegaly
results in a poor quality of life due to symptoms such as headache, fatigue, arthralgia, depression, sexual dysfunction and
hyperhidrosis; an increased prevalence of co-morbidities like diabetes, hypertension as well as cancer risk and a reduced
life expectancy. Appropriate, modern, multimodal treatment of acromegaly has led to a significant improvement in quality
of life, an adequate control of co-morbidities and a drastic reduction in the mortality rates that used to prevail in the past.
This multimodal strategy includes an adequate selection of patients who are likely to benefit from surgical treatment
(which has to be performed by a skilled pituitary neurosurgeon), the use of pharmacological interventions such as
somatostatin analogs and dopamine agonists, which target the pituitary adenoma; and pegvisomant, a GH mutant acting as
a competitive antagonist of the GH receptor. Radiation therapy is an important tool, particularly in parts of the World
where resources are limited. The ultimate outcome of the individual patient depends on the judicious use of all these
treatment options, which are critically analyzed in this mini-review.
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