Materiały źródłowe

• #1 Management of acromegaly

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2990454/

  Acromegaly is caused by hypersecretion of growth hormone and resultant overproduction of insulin-like growth factor-1 and is associated with increased mortality and morbidity. Successful treatment modalities have been developed and are used in a multistep approach allowing normal life expectancy as well as improved quality of life in an increasing number of patients. […] Therapeutic goals include control of GH and IGF-1 levels, tumor volume reduction for alleviating symptoms of mass effect and concomitant neurological disorders, preservation of pituitary function, improvement of long-term mortality and morbidity, and prevention of disease recurrence as well as increasing the quality of life of patients. […] Several consensus statements and clinical guidelines have been published recently clearly defining criteria for good disease control: suppression of GH to 0.4 g/l during oral glucose tolerance test or random GH values 1 g/l (using ultrasensitive assays) and age-adjusted normal levels of IGF-1. Strategies are now available to help physicians achieve more effective treatment of acromegaly. Surgery, pharmacological therapy, and radiotherapy are employed in a step-like approach to maintain disease control.

• #2 Acromegaly – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/acromegaly/symptoms-causes/syc-20351222

  Without treatment, acromegaly can lead to other serious and sometimes life-threatening health conditions called complications. But treatments such as surgery, medicine and radiation can lower the risk of complications. Treatment also can improve many acromegaly symptoms. […] Early treatment of acromegaly can prevent these complications or keep them from becoming worse. Without treatment, acromegaly and its complications can lead to early death.

• #3 Treatment of acromegaly – UpToDate

  https://www.uptodate.com/contents/treatment-of-acromegaly

  Treatment of acromegaly […] Acromegaly is almost always caused by a somatotroph (growth hormone [GH]-secreting) adenoma of the pituitary gland and is associated with increased morbidity and mortality. As a result, almost all patients should be treated, even those who are asymptomatic and those in whom the disorder does not seem to be progressing. One exception is a patient with a short life expectancy who is not expected to live long enough to benefit from therapy. […] The treatment of acromegaly will be reviewed here. The clinical manifestations and diagnosis of acromegaly are discussed separately. […] The goals of therapy in patients with acromegaly are to lower the serum insulin-like growth factor-1 (IGF-1) concentration to within the normal range for the patient’s age and gender, control adenoma size and reduce mass effects, improve symptoms, and reverse metabolic abnormalities such as diabetes mellitus.

• #4 Management of acromegaly

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2990454/

  Acromegaly is caused by hypersecretion of growth hormone and resultant overproduction of insulin-like growth factor-1 and is associated with increased mortality and morbidity. Successful treatment modalities have been developed and are used in a multistep approach allowing normal life expectancy as well as improved quality of life in an increasing number of patients. […] Therapeutic goals include control of GH and IGF-1 levels, tumor volume reduction for alleviating symptoms of mass effect and concomitant neurological disorders, preservation of pituitary function, improvement of long-term mortality and morbidity, and prevention of disease recurrence as well as increasing the quality of life of patients. […] Several consensus statements and clinical guidelines have been published recently clearly defining criteria for good disease control: suppression of GH to 0.4 g/l during oral glucose tolerance test or random GH values 1 g/l (using ultrasensitive assays) and age-adjusted normal levels of IGF-1. Strategies are now available to help physicians achieve more effective treatment of acromegaly. Surgery, pharmacological therapy, and radiotherapy are employed in a step-like approach to maintain disease control.

• #5 Management of acromegaly

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2990454/

  Acromegaly is caused by hypersecretion of growth hormone and resultant overproduction of insulin-like growth factor-1 and is associated with increased mortality and morbidity. Successful treatment modalities have been developed and are used in a multistep approach allowing normal life expectancy as well as improved quality of life in an increasing number of patients. […] Therapeutic goals include control of GH and IGF-1 levels, tumor volume reduction for alleviating symptoms of mass effect and concomitant neurological disorders, preservation of pituitary function, improvement of long-term mortality and morbidity, and prevention of disease recurrence as well as increasing the quality of life of patients. […] Several consensus statements and clinical guidelines have been published recently clearly defining criteria for good disease control: suppression of GH to 0.4 g/l during oral glucose tolerance test or random GH values 1 g/l (using ultrasensitive assays) and age-adjusted normal levels of IGF-1. Strategies are now available to help physicians achieve more effective treatment of acromegaly. Surgery, pharmacological therapy, and radiotherapy are employed in a step-like approach to maintain disease control.

• #6 Medical Therapy of Acromegaly

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3328958/

  Indications for medical therapy are failure to sufficiently reduce GH secretion by surgery, bridging the time lag until complete remission will be achieved after irradiation, the rare patient with contraindication to surgery. Recommended criteria for initiation of medical therapy are an insufficiently suppressed GH nadir (1g/L) during an oral glucose load, an increased age-adjusted IGF-1 concentration. […] Medical therapy aims to achieve complete remission. Thus criteria already discussed will guide therapeutic decisions. Any deviation will be discussed when appropriate. The available drugs are long-acting somatostatin receptor ligands, dopamine agonists with low overall efficacy and the highly effective GH antagonist Pegvisomant. […] SRL inhibit both, the physiological and the autonomous GH secretion. No tachyphylaxia has been observed during long-term therapy.

• #7 Acromegaly – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/acromegaly/diagnosis-treatment/drc-20351226

  Acromegaly treatment aims to improve symptoms and treat or prevent complications. The goal is to lower growth hormone and IGF-1 back to their proper levels and keep them there. […] To help lower your growth hormone (GH) and IGF-1 levels, treatment options often include: […] Surgery to remove the tumor that’s causing symptoms. Most often, this is the first treatment for acromegaly that’s caused by a pituitary gland tumor. […] Medicine to help lower hormone levels. This is usually an option if surgery doesn’t bring down growth hormone to the right level. […] Radiation to shrink the size of the tumor. Often, this a treatment choice if surgery isn’t an option. It’s also an option if surgery can’t remove the whole tumor or if medicine doesn’t help enough. […] Some people need a mix of these treatments. Your treatment plan depends on factors such as:

• #8 Management of acromegaly

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2990454/

  Dopamine agonists have been used for the management of acromegaly for more than 30 years but low efficacy has discouraged their adoption as monotherapy. […] Radiotherapy can be employed as third- or second-line treatment in patients with persistent or recurrent tumors after surgery and who are resistant or intolerant to pharmacological agents. […] The combined use of the different treatment approaches allows for attaining disease control or even complete cure in an increasing proportion of patients.

• #9 Gigantism and Acromegaly Treatment & Management: Approach Considerations, Pharmacologic Therapy, Transsphenoidal Surgery

  https://emedicine.medscape.com/article/925446-treatment

  Most experts define cure, or adequate control, of growth hormone (GH) excess as a glucose-suppressed GH concentration of less than 2 ng/mL, as determined by radioimmunoassay (1 mcg/L by IRMA), and normalization of the serum insulinlike growth factor I (IGF-I) concentration. […] For pituitary adenomas, transsphenoidal surgery is usually considered the first line of treatment, followed by medical therapy for residual disease. […] Radiation treatment usually is reserved for recalcitrant cases. […] Surgery may lower it by avoiding lifelong pharmacologic therapy. […] Slow-release formulations of somatostatin are now widely used (including as a primary treatment) and appear to be safe and effective in 50-60% of the patients. A GH-receptor blocking agent, pegvisomant, appears to normalize IGF-I levels in almost all patients.

• #10 Acromegaly – Causes, Symptoms, TreatmentsSecond Opinion IconSecond Opinion IconGroup 9Group 49

  https://www.barrowneuro.org/condition/acromegaly/

  Most commonly caused by a noncancerous tumor of the pituitary gland (pituitary adenoma), acromegaly is often cured with surgery. Whether or not the entire tumor can be removed depends on its size and if it’s grown into nearby organ or tissue structures. […] The goal of acromegaly treatment is to control tumor size, normalize GH and IGF-1 levels, improve symptoms, and prevent complications. […] An operation by an experienced pituitary neurosurgeon is the first line of treatment and the only method for reaching a true cure for acromegaly. […] Treatment with prescription medication is possible if surgery does not cause remission in your acromegaly or if surgery is not recommended due to other reasons specific. […] Gamma Knife radiosurgery is a highly advanced form of accurate radiation therapy that achieves results similar to those in the surgical techniques described above. […] However, it can take several years for GH levels to return to normal using the Gamma Knife rather than the days or weeks with traditional surgery. As a result, Gamma Knife is often a last resort treatment for acromegaly after surgery and medications.

• #11 Acromegaly | UVA Health

  https://uvahealth.com/services/benign-brain-tumor/acromegaly

  Acromegaly can lead to gigantism in children and adolescents. […] At UVA Health, you’ll find experts who specialize in treating this and other brain conditions. Surgery to remove the tumor can help relieve symptoms. […] At UVA Health, you’ll have a team who will tailor treatment for you. They’ll aim to: Restore production of GH to normal, Stop and reverse the symptoms of acromegaly, Correct other endocrine abnormalities, Remove and or destroy the tumor to restore endocrine function to normal and to relieve any symptoms directly related to the tumor. […] Your doctor may prescribe medication to reduce the level of GH secretion. These include medications that act like dopamine and growth hormone antagonists. […] In most cases, removing the tumor through surgery is the preferred treatment. This can be done through the nose. Known as a transsphenoidal operation, it won’t disturb the brain or the eye nerves.

• #12 Acromegaly | Stanford Health Care

  https://stanfordhealthcare.org/medical-conditions/brain-and-nerves/acromegaly.html

  Surgery for acromegaly is a delicate procedure, which should be performed by highly specialized surgeons at multidisciplinary Pituitary centers. In the past, the most common operation was an approach called microscopic transsphenoidal surgery. At Stanford, our neurosurgeons and rhinologists use a more advanced endoscopic endonasal approach to access the pituitary gland through the nostrils. Our operating rooms are equipped with 4K endoscopic visualization technology and very fine instruments. […] […] Medication or radiation therapy may be recommended after surgery to help normalize levels of growth hormone. At Stanford, less than 10% of patients require medical treatment secondary to the high success rate of surgery. […] […] There are 3 medical therapies: Monthly injections of medications that mimic natural growth hormone inhibitors are effective in about two-thirds of patients. Sometimes, these medications may be used before surgery to try to shrink the tumors and is effective in roughly 40% of patients. Side effects include digestive problems such as loose stools, nausea, and gas in one third of patients. About 25 percent of patients develop gallstones, which are usually asymptomatic. […]

• #13 Acromegaly | Stanford Health Care

  https://stanfordhealthcare.org/medical-conditions/brain-and-nerves/acromegaly.html

  Acromegaly Treatment […] Our team of neurosurgeons, neuroendocrinologists, radiation oncologists and other specialists work together to develop an individualized treatment plan for your needs. Our expertise helps us determine whether and when you need treatment or support. […] […] Success of surgery depends on the size and location of the tumor, and the experience and skills of the neurosurgeon. For example, surgery is more successful with a tumor smaller than 10-millimeters compared with a tumor greater than 10-millimeters in size. In our experience, more than 90% of patients have normal GH and IGF-1 hormone levels following surgery. The expertise of the surgical team is a key factor in achieving best possible results with very low complication rates. Recent surgical innovations introduced by Dr. Fernandez-Miranda, such has removal of the medial wall of the cavernous sinus and removal of cavernous sinus tumors, have significantly improved surgical outcomes in acromegalic patients. […]

• #14 Gigantism and Acromegaly Treatment & Management: Approach Considerations, Pharmacologic Therapy, Transsphenoidal Surgery

  https://emedicine.medscape.com/article/925446-treatment

  Most experts define cure, or adequate control, of growth hormone (GH) excess as a glucose-suppressed GH concentration of less than 2 ng/mL, as determined by radioimmunoassay (1 mcg/L by IRMA), and normalization of the serum insulinlike growth factor I (IGF-I) concentration. […] For pituitary adenomas, transsphenoidal surgery is usually considered the first line of treatment, followed by medical therapy for residual disease. […] Radiation treatment usually is reserved for recalcitrant cases. […] Surgery may lower it by avoiding lifelong pharmacologic therapy. […] Slow-release formulations of somatostatin are now widely used (including as a primary treatment) and appear to be safe and effective in 50-60% of the patients. A GH-receptor blocking agent, pegvisomant, appears to normalize IGF-I levels in almost all patients.

• #15 Acromegaly – Pituitary & Skull Base Tumor | UCLA Health

  https://www.uclahealth.org/medical-services/neurosurgery/pituitary-skull-base-tumor/conditions/pituitary-adenomas/acromegaly

  Your doctor may recommend surgically removing the tumors as your best chance for a cure. If the tumor invaded beyond the sella (the space where the normal pituitary gland sits), however, there is a lower chance of a surgical cure. In that case, your doctor may recommend other treatment options, such as medication or radiation therapy. Patients should strongly consider seeking the care of an experienced neurosurgeon, one whom performs a large number of pituitary surgeries each year. Studies have shown: The first surgery offers the greatest chance of cure, while the cure rate with a second or third surgery is much lower. Newer surgical techniques, such as the expanded, endoscopic endonasal approach allow surgeons to cure pituitary tumors previously thought to be unresectable (unable to be removed surgically). Long-term cure of acromegaly after surgery occurs in approximately 80 percent to 85 percent of patients with smaller tumors (microadenomas) and in approximately 50 percent to 60 percent of patients with larger tumors (macroadenomas).

• #16 Acromegaly | Stanford Health Care

  https://stanfordhealthcare.org/medical-conditions/brain-and-nerves/acromegaly.html

  Acromegaly Treatment […] Our team of neurosurgeons, neuroendocrinologists, radiation oncologists and other specialists work together to develop an individualized treatment plan for your needs. Our expertise helps us determine whether and when you need treatment or support. […] […] Success of surgery depends on the size and location of the tumor, and the experience and skills of the neurosurgeon. For example, surgery is more successful with a tumor smaller than 10-millimeters compared with a tumor greater than 10-millimeters in size. In our experience, more than 90% of patients have normal GH and IGF-1 hormone levels following surgery. The expertise of the surgical team is a key factor in achieving best possible results with very low complication rates. Recent surgical innovations introduced by Dr. Fernandez-Miranda, such has removal of the medial wall of the cavernous sinus and removal of cavernous sinus tumors, have significantly improved surgical outcomes in acromegalic patients. […]

• #17 Acromegaly | WELCOME TO DRJFM.COM

  https://www.drjfm.com/acromegaly

  Taming Goliath: A surgical revolution in acromegaly treatment […] Early diagnosis and appropriate therapy may lead to reversal and/or prevention of these long-term consequences. […] The success of surgery for acromegaly is defined by normalization of IGF-1 levels 3 to 6 months after surgery. […] However, after the introduction of the technique for surgical resection of the medial wall of cavernous sinus, the remission rates in the last 30 consecutive patients have improved to over 90%. […] No patients have suffered injury to the carotid artery or permanent double vision, and the need for medical treatment or radiotherapy after surgery has been greatly reduced.

• #18 Acromegaly – Pituitary & Skull Base Tumor | UCLA Health

  https://www.uclahealth.org/medical-services/neurosurgery/pituitary-skull-base-tumor/conditions/pituitary-adenomas/acromegaly

  Your doctor may recommend surgically removing the tumors as your best chance for a cure. If the tumor invaded beyond the sella (the space where the normal pituitary gland sits), however, there is a lower chance of a surgical cure. In that case, your doctor may recommend other treatment options, such as medication or radiation therapy. Patients should strongly consider seeking the care of an experienced neurosurgeon, one whom performs a large number of pituitary surgeries each year. Studies have shown: The first surgery offers the greatest chance of cure, while the cure rate with a second or third surgery is much lower. Newer surgical techniques, such as the expanded, endoscopic endonasal approach allow surgeons to cure pituitary tumors previously thought to be unresectable (unable to be removed surgically). Long-term cure of acromegaly after surgery occurs in approximately 80 percent to 85 percent of patients with smaller tumors (microadenomas) and in approximately 50 percent to 60 percent of patients with larger tumors (macroadenomas).

• #19 Acromegaly – Causes, Symptoms, TreatmentsSecond Opinion IconSecond Opinion IconGroup 9Group 49

  https://www.barrowneuro.org/condition/acromegaly/

  Most commonly caused by a noncancerous tumor of the pituitary gland (pituitary adenoma), acromegaly is often cured with surgery. Whether or not the entire tumor can be removed depends on its size and if it’s grown into nearby organ or tissue structures. […] The goal of acromegaly treatment is to control tumor size, normalize GH and IGF-1 levels, improve symptoms, and prevent complications. […] An operation by an experienced pituitary neurosurgeon is the first line of treatment and the only method for reaching a true cure for acromegaly. […] Treatment with prescription medication is possible if surgery does not cause remission in your acromegaly or if surgery is not recommended due to other reasons specific. […] Gamma Knife radiosurgery is a highly advanced form of accurate radiation therapy that achieves results similar to those in the surgical techniques described above. […] However, it can take several years for GH levels to return to normal using the Gamma Knife rather than the days or weeks with traditional surgery. As a result, Gamma Knife is often a last resort treatment for acromegaly after surgery and medications.

• #20 Treatment of Acromegaly – Pituitary Foundation

  https://www.pituitary.org.uk/information/acromegaly-treatment/

  Acromegaly is a hormonal disorder that results from too much Growth Hormone in the body. Some people need surgery to remove a tumour and others take medication. […] Treatment options include surgery, medical therapy and radiotherapy. The goals of treatment are to reduce excess GH, relieve pressure that the growing tumour may be exerting, e.g on the eye nerve, preserve normal pituitary function and improve symptoms of acromegaly. […] Some people may need surgery to remove the tumour. […] Surgery will normally lower your growth hormone levels, but in some instances the acromegaly is not cured. In such cases, consideration will be given to treating you further with drug therapy and/or radiotherapy. […] There are three types of drugs for treating acromegaly each act by different mechanisms: Somatostatin Analogues work on specialist markers (somatostatin receptors) to inhibit GH release from the pituitary tumour.

• #21 Acromegaly – Causes, Symptoms, TreatmentsSecond Opinion IconSecond Opinion IconGroup 9Group 49

  https://www.barrowneuro.org/condition/acromegaly/

  Most commonly caused by a noncancerous tumor of the pituitary gland (pituitary adenoma), acromegaly is often cured with surgery. Whether or not the entire tumor can be removed depends on its size and if it’s grown into nearby organ or tissue structures. […] The goal of acromegaly treatment is to control tumor size, normalize GH and IGF-1 levels, improve symptoms, and prevent complications. […] An operation by an experienced pituitary neurosurgeon is the first line of treatment and the only method for reaching a true cure for acromegaly. […] Treatment with prescription medication is possible if surgery does not cause remission in your acromegaly or if surgery is not recommended due to other reasons specific. […] Gamma Knife radiosurgery is a highly advanced form of accurate radiation therapy that achieves results similar to those in the surgical techniques described above. […] However, it can take several years for GH levels to return to normal using the Gamma Knife rather than the days or weeks with traditional surgery. As a result, Gamma Knife is often a last resort treatment for acromegaly after surgery and medications.

• #22 Acromegaly | UVA Health

  https://uvahealth.com/services/benign-brain-tumor/acromegaly

  Acromegaly can lead to gigantism in children and adolescents. […] At UVA Health, you’ll find experts who specialize in treating this and other brain conditions. Surgery to remove the tumor can help relieve symptoms. […] At UVA Health, you’ll have a team who will tailor treatment for you. They’ll aim to: Restore production of GH to normal, Stop and reverse the symptoms of acromegaly, Correct other endocrine abnormalities, Remove and or destroy the tumor to restore endocrine function to normal and to relieve any symptoms directly related to the tumor. […] Your doctor may prescribe medication to reduce the level of GH secretion. These include medications that act like dopamine and growth hormone antagonists. […] In most cases, removing the tumor through surgery is the preferred treatment. This can be done through the nose. Known as a transsphenoidal operation, it won’t disturb the brain or the eye nerves.

• #23 Acromegaly | UVA Health

  https://uvahealth.com/services/benign-brain-tumor/acromegaly

  Once your surgeon removes the tumor, the imbalance of IGF and GH hormone returns to normal; this may take several months. […] Many acromegaly symptoms improve, and you can eventually sleep better and discontinue taking medications for diabetes and high blood pressure. This usually takes weeks to months. […] Radiotherapy is most often performed after surgery has removed the majority of the tumor, but some tumor remains. […] Because any type of pituitary tumor may recur, regular follow up with blood tests is necessary. If a recurrent tumor is found, additional treatment is necessary.

• #24 Acromegaly – Pituitary & Skull Base Tumor | UCLA Health

  https://www.uclahealth.org/medical-services/neurosurgery/pituitary-skull-base-tumor/conditions/pituitary-adenomas/acromegaly

  Your doctor may recommend surgically removing the tumors as your best chance for a cure. If the tumor invaded beyond the sella (the space where the normal pituitary gland sits), however, there is a lower chance of a surgical cure. In that case, your doctor may recommend other treatment options, such as medication or radiation therapy. Patients should strongly consider seeking the care of an experienced neurosurgeon, one whom performs a large number of pituitary surgeries each year. Studies have shown: The first surgery offers the greatest chance of cure, while the cure rate with a second or third surgery is much lower. Newer surgical techniques, such as the expanded, endoscopic endonasal approach allow surgeons to cure pituitary tumors previously thought to be unresectable (unable to be removed surgically). Long-term cure of acromegaly after surgery occurs in approximately 80 percent to 85 percent of patients with smaller tumors (microadenomas) and in approximately 50 percent to 60 percent of patients with larger tumors (macroadenomas).

• #25 Acromegaly – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/acromegaly/diagnosis-treatment/drc-20351226

  It’s common for some changes in physical features to improve with treatment. For example, swelling of soft tissue often goes down. And the skin often becomes less oily and coarse. But enlarged bones don’t return to the size that they used to be. […] If you also have other health conditions due to acromegaly, you may need other treatments to manage them. […] Removing the tumor often returns growth hormone to the right level, especially if the tumor is small. […] Sometimes, surgeons can’t remove the whole tumor. When this happens, the level of growth hormone may still be too high after surgery. Another surgery, medicines or radiation treatments may be needed. […] Medicine can help lower hormone levels or block the hormones’ effects. Your healthcare professional may recommend one or more of the following:

• #26

  https://myhealth.alberta.ca/Health/aftercareinformation/pages/conditions.aspx?hwid=ut2956

  Acromegaly is often caused by a tumour of the pituitary gland, which is where growth hormone is made. But the tumour isn’t cancer. It can be treated with medicine, surgery, radiation treatment, or some combination of these. […] Treatment may stop some abnormal growth, but bones don’t go back to normal after the treatment.

• #27 Acromegaly – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/acromegaly/symptoms-causes/syc-20351222

  Without treatment, acromegaly can lead to other serious and sometimes life-threatening health conditions called complications. But treatments such as surgery, medicine and radiation can lower the risk of complications. Treatment also can improve many acromegaly symptoms. […] Early treatment of acromegaly can prevent these complications or keep them from becoming worse. Without treatment, acromegaly and its complications can lead to early death.

• #28 Medical Therapy of Acromegaly

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3328958/

  This paper outlines the present status of medical therapy of acromegaly. Indications for permanent postoperative treatment, postirradiation treatment to bridge the interval until remission as well as primary medical therapy are elaborated. Therapeutic efficacy of the different available drugs somatostatin receptor ligands (SRLs), dopamine agonists, and the GH antagonist Pegvisomant is discussed, as are the indications for and efficacy of their respective combinations. Information on their mechanism of action, and some pharmacokinetic data are included. Special emphasis is given to the difficulties to define remission criteria of acromegaly due to technical assay problems. An algorithm for medical therapy in acromegaly is provided. […] Medical therapy is indicated in those acromegalic patients, who failed to achieve remission after surgery or in the rare patient with contraindication for surgical therapy. In addition, it is used in patients following radiotherapy in order to bridge the interval until complete remission.

• #29 Practical guidelines for diagnosis and treatment of acromegaly | Endocrinología y Nutrición (English Edition)

  https://www.elsevier.es/en-revista-endocrinologia-nutricion-412-articulo-practical-guidelines-for-diagnosis-treatment-S2173509313001670

  Three treatment modalities currently exist: surgery, medical treatment, and radiotherapy. […] Surgery continues to be the treatment of choice for acromegaly in most patients (Grade B), although advances in medical treatment in recent years have changed the treatment sequence. […] Radiotherapy is currently the last step in the treatment scheme, being reserved for patients not controlled after initial medical or surgical treatment and for uncontrolled, invasive macroadenomas (Grade C). […] It is important that patients are cared for by a multidisciplinary team consisting of experienced endocrinologists, neurosurgeons, and radiation therapists able to recommend the most adequate treatment in each case (Grade C). […] Medical treatment of acromegaly may be prescribed as follows: 1. As primary treatment for patients who have a significant surgical risk, in those with a low chance of cure because the tumor has extrasellar extension, without chiasm compression, and in patients who refuse surgery and choose medical treatment (Grade C). 2. As supplemental treatment after surgery failure or in the interim period until radiotherapy becomes effective (Grade B). 3. It may also be prescribed as pre-treatment before surgery to improve the anesthetic conditions in the patients or the results of surgery itself, or in patients in whom surgery is delayed.

• #30 Management of acromegaly

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2990454/

  Transsphenoidal surgery is the preferred first-line treatment for patients with acromegaly that have intrasellar microadenomas, noninvasive macroadenomas or patients in whom the tumor is causing compression symptoms. […] Three classes of drugs are currently available for the treatment of acromegaly: SRLs, GH receptor antagonists, and dopamine agonists. Pharmacological therapy is mainly indicated when surgery fails to achieve remission but is increasingly considered as primary medical treatment. […] SRLs are analogues of natural somatostatin and exert their effects by binding to somatostatin receptors (SSTRs) on pituitary somatotrope cells, thus suppressing GH secretion. […] Pegvisomant is the only currently available GH receptor antagonist. It acts by preventing GH receptor dimerization, thus blocking GH effects in the periphery, including the production of IGF-1.

• #31 Practical guidelines for diagnosis and treatment of acromegaly | Endocrinología y Nutrición (English Edition)

  https://www.elsevier.es/en-revista-endocrinologia-nutricion-412-articulo-practical-guidelines-for-diagnosis-treatment-S2173509313001670

  There are currently three drug classes that may potentially be used: SSAs, dopamine agonists, and peripheral GH antagonists (Grade A). […] Pegvisomant is the drug that best controls IGF-1 levels in acromegaly (Grade A), but its use is only currently approved in the event of SSA failure or when SSAs cannot be used because of their adverse effects.

• #32 Gigantism and Acromegaly Treatment & Management: Approach Considerations, Pharmacologic Therapy, Transsphenoidal Surgery

  https://emedicine.medscape.com/article/925446-treatment

  For most patients with acromegaly, surgical removal of the pituitary gland tumor should be considered the primary treatment. […] Medical therapy should be administered only to patients with persistent postoperative disease. […] Somatostatin and dopamine analogues and GH-receptor antagonists are the mainstays of medical treatment for GH excess and are generally used when primary surgery fails to induce complete remission. […] The most extensively studied and used somatostatin analogue, octreotide, binds to the somatostatin receptor subtypes II and V, inhibiting GH secretion. […] Primary treatment with depot octreotide and lanreotide has been found to induce tumor shrinkage in newly diagnosed acromegaly. […] Dopamine-receptor agonists are generally used as adjuvant medical treatments for GH excess, and their effectiveness may be added to that of octreotide.

• #33 Management of acromegaly

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2990454/

  Transsphenoidal surgery is the preferred first-line treatment for patients with acromegaly that have intrasellar microadenomas, noninvasive macroadenomas or patients in whom the tumor is causing compression symptoms. […] Three classes of drugs are currently available for the treatment of acromegaly: SRLs, GH receptor antagonists, and dopamine agonists. Pharmacological therapy is mainly indicated when surgery fails to achieve remission but is increasingly considered as primary medical treatment. […] SRLs are analogues of natural somatostatin and exert their effects by binding to somatostatin receptors (SSTRs) on pituitary somatotrope cells, thus suppressing GH secretion. […] Pegvisomant is the only currently available GH receptor antagonist. It acts by preventing GH receptor dimerization, thus blocking GH effects in the periphery, including the production of IGF-1.

• #34 Medical Treatment with Somatostatin Analogues in Acromegaly: Position Statement

  https://www.e-enm.org/journal/view.php?doi=10.3803/EnM.2019.34.1.53

  When surgical treatments are unavailable or are refused by patients, medical treatments may be considered as primary therapy. […] The initial dose of octreotide long-acting release (LAR) is 20 mg, administered by intramuscular injection at 4-week intervals. […] If octreotide LAR fails to suppress serum GH concentrations below 2.5 g/L after the first 3 months of use, the dose may be increased to 30 mg every 4 weeks. […] The initial dose of lanreotide autogel (ATG) can be administered at an initial dose of 60, 90, or 120 mg every 4 weeks. […] The initial dose of pasireotide LAR is 40 mg every 4 weeks. […] The routine use of preoperative somatostatin analogues prior to surgical excision of pituitary adenomas is not recommended; however, when surgical treatment is not available or refused, medical treatment may be considered as primary therapy. […] Somatostatin analogues may be used when complete recovery cannot be achieved by surgical excision of GH-secreting pituitary adenomas or the patient declines surgery.

• #35 Treatment of Acromegaly – Pituitary Foundation

  https://www.pituitary.org.uk/information/acromegaly-treatment/

  Octreotide and Lanreotide help the symptoms of acromegaly by reducing growth hormone levels into the target range of less than 1.8/2 ug/l in about half of patients. […] Pegvisomant is a blocker of the action of GH. […] Radiotherapy might be needed if not all the tumour could be removed in surgery or if it was not possible for you to have an operation. […] Once treatment is successful, you should notice that the soft tissue in your hands and feet decrease in size and patients often notice that their facial features gradually return towards normal.

• #36 Medical Treatment with Somatostatin Analogues in Acromegaly: Position Statement

  https://www.e-enm.org/journal/view.php?doi=10.3803/EnM.2019.34.1.53

  When surgical treatments are unavailable or are refused by patients, medical treatments may be considered as primary therapy. […] The initial dose of octreotide long-acting release (LAR) is 20 mg, administered by intramuscular injection at 4-week intervals. […] If octreotide LAR fails to suppress serum GH concentrations below 2.5 g/L after the first 3 months of use, the dose may be increased to 30 mg every 4 weeks. […] The initial dose of lanreotide autogel (ATG) can be administered at an initial dose of 60, 90, or 120 mg every 4 weeks. […] The initial dose of pasireotide LAR is 40 mg every 4 weeks. […] The routine use of preoperative somatostatin analogues prior to surgical excision of pituitary adenomas is not recommended; however, when surgical treatment is not available or refused, medical treatment may be considered as primary therapy. […] Somatostatin analogues may be used when complete recovery cannot be achieved by surgical excision of GH-secreting pituitary adenomas or the patient declines surgery.

• #37 Medical Treatment with Somatostatin Analogues in Acromegaly: Position Statement

  https://www.e-enm.org/journal/view.php?doi=10.3803/EnM.2019.34.1.53

  When surgical treatments are unavailable or are refused by patients, medical treatments may be considered as primary therapy. […] The initial dose of octreotide long-acting release (LAR) is 20 mg, administered by intramuscular injection at 4-week intervals. […] If octreotide LAR fails to suppress serum GH concentrations below 2.5 g/L after the first 3 months of use, the dose may be increased to 30 mg every 4 weeks. […] The initial dose of lanreotide autogel (ATG) can be administered at an initial dose of 60, 90, or 120 mg every 4 weeks. […] The initial dose of pasireotide LAR is 40 mg every 4 weeks. […] The routine use of preoperative somatostatin analogues prior to surgical excision of pituitary adenomas is not recommended; however, when surgical treatment is not available or refused, medical treatment may be considered as primary therapy. […] Somatostatin analogues may be used when complete recovery cannot be achieved by surgical excision of GH-secreting pituitary adenomas or the patient declines surgery.

• #38 Acromegaly: Pathophysiological Considerations and Treatment Options Including the Evolving Role of Oral Somatostatin Analogs

  https://www.mdpi.com/1873-149X/30/3/29

  Acromegaly is a condition most commonly diagnosed in the fifth decade of life and has numerous treatment options. In this regard, Mycapssa® is the first FDA-approved oral octreotide capsule for treating acromegaly, combining the efficacy of the somatostatin receptor ligand, octreotide, with the ease of a twice-daily oral capsule. Where surgical treatment is not an option, somatostatin analogs, including octreotide, are the first line of medical treatment for acromegaly, requiring regular subcutaneous or intramuscular injections administered by a patient’s healthcare provider. Octreotide capsules (Mycapssa®) provide an alternative to these somatostatin receptor ligand injections by combining octreotide with other excipients to produce a transient permeability enhancer technology that improves paracellular transport of octreotide across the gastrointestinal wall into the small intestine.

• #39 Researchers offer hope for an oral, noninjectable treatment of acromegaly | Endocrine Society

  https://www.endocrine.org/news-and-advocacy/news-room/2020/researchers-offer-hope-for-an-oral-noninjectable-treatment-of-acromegaly

  Adults who need medical maintenance treatment of the growth hormone disorder acromegaly respond well to an investigational oral form of the drug octreotide, investigators of the Chiasma OPTIMAL study reported. […] The results of this study suggest that if oral octreotide capsules are approved by the Food and Drug Administration, this drug has the potential to expand the treatment options for adults with acromegaly beyond injectables, Samson said. […] If accepted, octreotide capsules would become the first oral somatostatin analog for treatment of acromegaly in adults, according to Chiasma, which funded the OPTIMAL (Octreotide capsules vs. Placebo Treatment In MultinationAL centers) study. […] Octreotide capsules appeared safe and well tolerated, she said, adding that 90 percent of patients completing oral octreotide therapy chose to continue treatment in a long-term extension study.

• #40 Medical Therapy for Acromegaly | California Center for Pituitary Disorders

  https://ccpd.ucsf.edu/news/medical-therapy-acromegaly

  Some patients will have residual acromegaly despite undergoing a successful transsphenoidal surgical procedure by experienced neurosurgeons. Fortunately, there are a number of pharmacologic agents that have demonstrated efficacy in the management of patients with residual and recurrent acromegaly and in those who are not candidates for primary surgery. […] At the California Center for Pituitary Disorders, cabergoline is the preferred dopamine agonist drug for acromegaly. […] Somatostatin receptors are expressed in one half to two thirds of growth-hormone-secreting pituitary tumors. […] Normalization of IGF-I levels are achieved in roughly 50 to 65% of patients treated with these agents. […] Pegvisomant is a growth hormone receptor antagonist that is often used to treat patients with acromegaly refractory to surgery and radiotherapy. IGF-I levels can be normalized in as many as 95% of patients.

• #41 Precision Therapy in Acromegaly Caused by Pituitary Tumors: How Close Is It to Reality?

  https://www.e-enm.org/journal/view.php?doi=10.3803/EnM.2020.35.2.206

  To date, SSAs, like octreotide, and lanreotide have been the most commonly used drugs, being used at least once in a given patient in 6% to 61% of the time. […] SSA achieve biochemical remission in approximate 55%, while tumor size shrinkage is observed in 80% of the cases. […] Unfortunately, 20% to 25% of acromegaly patients are resistant to SSA, requiring the use of either DAs or growth hormone receptor antagonist (GHRI). […] Combined medical treatment has been on the rise, as reported by Strasburger et al. […] GHRI monotherapy, SSA+GHRI and DA+GHRI have a similar incidence in adverse events, suggesting the high efficacy and safety for pegvisomant use. […] Nowadays, personalizing management of acromegaly does not persist in theory, but is slowly being integrated into reality.

• #42 Acromegaly – Pituitary & Skull Base Tumor | UCLA Health

  https://www.uclahealth.org/medical-services/neurosurgery/pituitary-skull-base-tumor/conditions/pituitary-adenomas/acromegaly

  In recent years, the medical treatment of acromegaly has improved. In some cases, doctors use medication, and not surgery, as the first course of treatment. However, in many cases, patients require both medical and surgical therapies to control acromegaly. Medications include: Somatostatin analog (Octreotide, Lanreotide) injections, typically administered to patients on a monthly basis, suppress growth hormone production in about 70 percent of patients. Significant tumor shrinkage occurs in 30 to 50 percent of patients. Injections often improve symptoms of soft tissue swelling, headache, joint pains and sleep apnea. Patients require lifelong treatment with somatostatin. […] For some patients, surgery or medication is not sufficient to control the acromegaly. In these cases, doctors may recommend stereotactic radiosurgery. Stereotactic radiosurgery is a technique in which doctors aim a highly focused dose of radiation to the tumor. It takes an average of 18 months to lower the GH and IGF-1 levels.

• #43 Acromegaly – Pituitary & Skull Base Tumor | UCLA Health

  https://www.uclahealth.org/medical-services/neurosurgery/pituitary-skull-base-tumor/conditions/pituitary-adenomas/acromegaly

  In recent years, the medical treatment of acromegaly has improved. In some cases, doctors use medication, and not surgery, as the first course of treatment. However, in many cases, patients require both medical and surgical therapies to control acromegaly. Medications include: Somatostatin analog (Octreotide, Lanreotide) injections, typically administered to patients on a monthly basis, suppress growth hormone production in about 70 percent of patients. Significant tumor shrinkage occurs in 30 to 50 percent of patients. Injections often improve symptoms of soft tissue swelling, headache, joint pains and sleep apnea. Patients require lifelong treatment with somatostatin. […] For some patients, surgery or medication is not sufficient to control the acromegaly. In these cases, doctors may recommend stereotactic radiosurgery. Stereotactic radiosurgery is a technique in which doctors aim a highly focused dose of radiation to the tumor. It takes an average of 18 months to lower the GH and IGF-1 levels.

• #44 Management of acromegaly

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2990454/

  Transsphenoidal surgery is the preferred first-line treatment for patients with acromegaly that have intrasellar microadenomas, noninvasive macroadenomas or patients in whom the tumor is causing compression symptoms. […] Three classes of drugs are currently available for the treatment of acromegaly: SRLs, GH receptor antagonists, and dopamine agonists. Pharmacological therapy is mainly indicated when surgery fails to achieve remission but is increasingly considered as primary medical treatment. […] SRLs are analogues of natural somatostatin and exert their effects by binding to somatostatin receptors (SSTRs) on pituitary somatotrope cells, thus suppressing GH secretion. […] Pegvisomant is the only currently available GH receptor antagonist. It acts by preventing GH receptor dimerization, thus blocking GH effects in the periphery, including the production of IGF-1.

• #45 Management of acromegaly

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2990454/

  Transsphenoidal surgery is the preferred first-line treatment for patients with acromegaly that have intrasellar microadenomas, noninvasive macroadenomas or patients in whom the tumor is causing compression symptoms. […] Three classes of drugs are currently available for the treatment of acromegaly: SRLs, GH receptor antagonists, and dopamine agonists. Pharmacological therapy is mainly indicated when surgery fails to achieve remission but is increasingly considered as primary medical treatment. […] SRLs are analogues of natural somatostatin and exert their effects by binding to somatostatin receptors (SSTRs) on pituitary somatotrope cells, thus suppressing GH secretion. […] Pegvisomant is the only currently available GH receptor antagonist. It acts by preventing GH receptor dimerization, thus blocking GH effects in the periphery, including the production of IGF-1.

• #46 Medical Therapy of Acromegaly

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3328958/

  Pegvisomant treatment results in normalization of the IGF-1 concentration in 90% to 97% of patients with up to a maximal doses of 40mg/d s.c. or a median dose of Pegvisomant of 130mg/week. […] The GH-receptor antagonist Pegvisomant normalizes IGF-1 concentration in up to 97% of the patients. The dose is titrated to normalize IGF-1 concentration, because GH cannot be routinely measured and serve as an indicator for therapeutic efficacy, due to cross-reactivity of the routinely used GH assay with Pegvisomant. […] Medical therapy of acromegaly is indicated in patients who failed to achieve the current remission criteria, that is, (i) a GH nadir below 1g/L during a 75g oral glucose load, (ii) a normal age- and sex-adjusted IGF-1 concentration either after surgery or following radiotherapy.

• #47 Medical Therapy of Acromegaly

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3328958/

  Pegvisomant treatment results in normalization of the IGF-1 concentration in 90% to 97% of patients with up to a maximal doses of 40mg/d s.c. or a median dose of Pegvisomant of 130mg/week. […] The GH-receptor antagonist Pegvisomant normalizes IGF-1 concentration in up to 97% of the patients. The dose is titrated to normalize IGF-1 concentration, because GH cannot be routinely measured and serve as an indicator for therapeutic efficacy, due to cross-reactivity of the routinely used GH assay with Pegvisomant. […] Medical therapy of acromegaly is indicated in patients who failed to achieve the current remission criteria, that is, (i) a GH nadir below 1g/L during a 75g oral glucose load, (ii) a normal age- and sex-adjusted IGF-1 concentration either after surgery or following radiotherapy.

• #48 Acromegaly | Stanford Health Care

  https://stanfordhealthcare.org/medical-conditions/brain-and-nerves/acromegaly.html

  Oral medications that spur the release of dopamine may help reduce growth hormone secretion in a small number of pituitary tumors. […] […] A novel drug called Pegvisomant that acts as a growth hormone receptor may be a promising option for patients who do not respond to synthetic growth hormone inhibitors or other types of treatment. In selected patients, it may be considered as first line therapy. Pegvisomant is highly effective and may normalize IGF-1 hormone levels in up to 97% of patients. In some case, it may increase the size of the pituitary tumor. That is uncommon but MRIs are recommended to monitor the tumor. Pegvisomant may cause changes in liver function, so lab tests are recommended. […] […] Radiation therapy for acromegaly is usually reserved for patients who have tumor remaining after surgery. At Stanford, radiation treatment is recommended very rarely, less than 5% of patients, given the success rate of surgery. These patients commonly also receive medication to lower growth hormone levels. Radiation therapy may be given in divided doses over four to six weeks. This treatment lowers GH levels by about 50 percent over two to five years. […]

• #49 Medical Therapy of Acromegaly

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3328958/

  Pegvisomant treatment results in normalization of the IGF-1 concentration in 90% to 97% of patients with up to a maximal doses of 40mg/d s.c. or a median dose of Pegvisomant of 130mg/week. […] The GH-receptor antagonist Pegvisomant normalizes IGF-1 concentration in up to 97% of the patients. The dose is titrated to normalize IGF-1 concentration, because GH cannot be routinely measured and serve as an indicator for therapeutic efficacy, due to cross-reactivity of the routinely used GH assay with Pegvisomant. […] Medical therapy of acromegaly is indicated in patients who failed to achieve the current remission criteria, that is, (i) a GH nadir below 1g/L during a 75g oral glucose load, (ii) a normal age- and sex-adjusted IGF-1 concentration either after surgery or following radiotherapy.

• #50 Breakthroughs in Treatment Dosing Increase Access to Life-Changing Medication for Acromegaly Patients | Cedars-Sinai

  https://www.cedars-sinai.org/blog/life-changing-medication-for-acromegaly-patients.html

  Life-changing medication for acromegaly patients. […] For many patients with acromegaly, medications are the primary treatment strategy to control the disease. […] New research at the Cedars-Sinai Pituitary Center demonstrates that smaller doses of pegvisomant in combination with low-dose, long-acting somatostatin analog medications are equally effective at treating acromegaly as existing higher-dose treatment regimens and also comes at significantly lower costs to patients. […] „The very high cost of therapy for acromegaly and frequent denial of effective treatments by insurance are barriers to attaining disease control in many patients,” says Bonert, the study’s senior and corresponding author. […] The goal of the research, published in the Journal of Clinical Endocrinology Metabolism, was to determine whether more cost-effective pairings of long-acting somatostatin analog medications and less-frequent doses of pegvisomant could normalize levels of insulin growth factor (IGF-1).

• #51 A Consensus Statement on acromegaly therapeutic outcomes | Nature Reviews Endocrinology

  https://www.nature.com/articles/s41574-018-0058-5

  If clinically relevant residual tumour that is unsuitable for resection is present, patients not adequately controlled on first-generation SRLs could be considered for switching to pasireotide long-acting release. […] If there is pre-existing clinically relevant impaired glucose metabolism, patients not adequately controlled on first-generation SRLs should be switched to pegvisomant. […] We recommend patients be treated at pituitary tumour centres of excellence, where possible, to receive the best and most cost-effective care. […] Surgical resection of the pituitary adenoma by an experienced neurosurgeon is recommended where possible and represents the best opportunity for cure.

• #52 Management of acromegaly

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2990454/

  Dopamine agonists have been used for the management of acromegaly for more than 30 years but low efficacy has discouraged their adoption as monotherapy. […] Radiotherapy can be employed as third- or second-line treatment in patients with persistent or recurrent tumors after surgery and who are resistant or intolerant to pharmacological agents. […] The combined use of the different treatment approaches allows for attaining disease control or even complete cure in an increasing proportion of patients.

• #53 Medical Therapy for Acromegaly | California Center for Pituitary Disorders

  https://ccpd.ucsf.edu/news/medical-therapy-acromegaly

  Some patients will have residual acromegaly despite undergoing a successful transsphenoidal surgical procedure by experienced neurosurgeons. Fortunately, there are a number of pharmacologic agents that have demonstrated efficacy in the management of patients with residual and recurrent acromegaly and in those who are not candidates for primary surgery. […] At the California Center for Pituitary Disorders, cabergoline is the preferred dopamine agonist drug for acromegaly. […] Somatostatin receptors are expressed in one half to two thirds of growth-hormone-secreting pituitary tumors. […] Normalization of IGF-I levels are achieved in roughly 50 to 65% of patients treated with these agents. […] Pegvisomant is a growth hormone receptor antagonist that is often used to treat patients with acromegaly refractory to surgery and radiotherapy. IGF-I levels can be normalized in as many as 95% of patients.

• #54

  https://link.springer.com/article/10.1007/s11102-024-01397-w

  As adjuvant therapy, medical treatment was recommended for patients in whom biochemical control cannot be achieved after surgery, including somatostatin receptor ligands (SRL), dopamine agonists (DA), and GH receptor antagonists (GHRA). […] Octreotide, recently available in both injectable and oral formulations and lanreotide are recommended as first-line medical therapy, whereas the multireceptor-targeted SRL; pasireotide or the GHRA; pegvisomant (PEGV) are indicated as second-line medical therapy in patients resistant to octreotide or lanreotide. […] The DA, cabergoline is recommended only in mild acromegaly for monotherapy, or rarely in combination therapy. […] The aim of our study was to evaluate acromegaly medical treatment approaches and their outcomes in the centers involved in the audit fulfilling the definition of PTCOE, with the goal of providing a real-life perspective for standards of medical care in acromegaly.

• #55 Updates in Diagnosis and Treatment of Acromegaly | [current-page:pager]touchENDOCRINOLOGY

  https://touchendocrinology.com/pituitary/journal-articles/updates-in-diagnosis-and-treatment-of-acromegaly/

  Pharmacologic agents available for treatment of acromegaly include somatostatin-receptor ligands, GH-receptor antagonists and, in selected cases, dopamine agonists. […] Symptoms and quality of life (QoL) were recently evaluated in a 1-year, open-label study of lanreotide autogel in acromegaly treatment-nave patients. […] In patients resistant to first-generation SRLs, alternative options are high-dose regimens of SRL, pegvisomant, combination therapy of SRL with either cabergoline or pegvisomant, or the use of pasireotide. […] Pegvisomant is a US Food and Drug Administration-approved treatment for use after surgery. […] Cabergoline has been recommended by guidelines and consensus meetings to be considered in patients uncontrolled on SRL monotherapy who have baseline IGF-1 levels up to 1.5-2.2 times above the upper limit of normal.

• #56 Management of acromegaly

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2990454/

  Dopamine agonists have been used for the management of acromegaly for more than 30 years but low efficacy has discouraged their adoption as monotherapy. […] Radiotherapy can be employed as third- or second-line treatment in patients with persistent or recurrent tumors after surgery and who are resistant or intolerant to pharmacological agents. […] The combined use of the different treatment approaches allows for attaining disease control or even complete cure in an increasing proportion of patients.

• #57 Acromegaly – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/acromegaly/diagnosis-treatment/drc-20351226

  Acromegaly treatment aims to improve symptoms and treat or prevent complications. The goal is to lower growth hormone and IGF-1 back to their proper levels and keep them there. […] To help lower your growth hormone (GH) and IGF-1 levels, treatment options often include: […] Surgery to remove the tumor that’s causing symptoms. Most often, this is the first treatment for acromegaly that’s caused by a pituitary gland tumor. […] Medicine to help lower hormone levels. This is usually an option if surgery doesn’t bring down growth hormone to the right level. […] Radiation to shrink the size of the tumor. Often, this a treatment choice if surgery isn’t an option. It’s also an option if surgery can’t remove the whole tumor or if medicine doesn’t help enough. […] Some people need a mix of these treatments. Your treatment plan depends on factors such as:

• #58

  https://link.springer.com/article/10.1007/s11102-024-01397-w

  The present study showed a median biochemical control rate achieved by combination therapy in 83% of patients, a lower rate compared to literature derived from tertiary referral centers which showed up to 95% control rates by combination therapies and restoration of normal IGF-I levels. […] Consensus guidelines recommend adding PEGV therapy in patients without optimal control with octreotide or lanreotide monotherapy when there are concerns about diabetes and no tumor mass. […] The clear presence of uncontrolled patients in each treatment category suggests that there could be a room for improved efficacy of medical therapy, as well as for additional therapeutic tools, such as radiosurgery.

• #59 Medical Therapy for Acromegaly | California Center for Pituitary Disorders

  https://ccpd.ucsf.edu/news/medical-therapy-acromegaly

  Combined treatment for acromegaly with somatostatin analogs and pegvisomant is employed in the following settings: When there has been a partial response to somatostatin analog therapy, When tumor progression is seen in the setting of pegvisomant therapy alone, In patients who have normalized IGF-I levels on pegvisomant therapy yet have continued headaches, as low-dose, once-daily subcutaneous octreotide often will resolve the headache syndrome, When patients who have normalized IGF-I levels on therapy with somatostatin analogs have continued symptoms that might be directly related to ongoing growth-hormone hypersecretion.

• #60 Updates in Diagnosis and Treatment of Acromegaly | [current-page:pager]touchENDOCRINOLOGY

  https://touchendocrinology.com/pituitary/journal-articles/updates-in-diagnosis-and-treatment-of-acromegaly/

  Pharmacologic agents available for treatment of acromegaly include somatostatin-receptor ligands, GH-receptor antagonists and, in selected cases, dopamine agonists. […] Symptoms and quality of life (QoL) were recently evaluated in a 1-year, open-label study of lanreotide autogel in acromegaly treatment-nave patients. […] In patients resistant to first-generation SRLs, alternative options are high-dose regimens of SRL, pegvisomant, combination therapy of SRL with either cabergoline or pegvisomant, or the use of pasireotide. […] Pegvisomant is a US Food and Drug Administration-approved treatment for use after surgery. […] Cabergoline has been recommended by guidelines and consensus meetings to be considered in patients uncontrolled on SRL monotherapy who have baseline IGF-1 levels up to 1.5-2.2 times above the upper limit of normal.

• #61 Precision Therapy in Acromegaly Caused by Pituitary Tumors: How Close Is It to Reality?

  https://www.e-enm.org/journal/view.php?doi=10.3803/EnM.2020.35.2.206

  To date, SSAs, like octreotide, and lanreotide have been the most commonly used drugs, being used at least once in a given patient in 6% to 61% of the time. […] SSA achieve biochemical remission in approximate 55%, while tumor size shrinkage is observed in 80% of the cases. […] Unfortunately, 20% to 25% of acromegaly patients are resistant to SSA, requiring the use of either DAs or growth hormone receptor antagonist (GHRI). […] Combined medical treatment has been on the rise, as reported by Strasburger et al. […] GHRI monotherapy, SSA+GHRI and DA+GHRI have a similar incidence in adverse events, suggesting the high efficacy and safety for pegvisomant use. […] Nowadays, personalizing management of acromegaly does not persist in theory, but is slowly being integrated into reality.

• #62 Breakthroughs in Treatment Dosing Increase Access to Life-Changing Medication for Acromegaly Patients | Cedars-Sinai

  https://www.cedars-sinai.org/blog/life-changing-medication-for-acromegaly-patients.html

  Life-changing medication for acromegaly patients. […] For many patients with acromegaly, medications are the primary treatment strategy to control the disease. […] New research at the Cedars-Sinai Pituitary Center demonstrates that smaller doses of pegvisomant in combination with low-dose, long-acting somatostatin analog medications are equally effective at treating acromegaly as existing higher-dose treatment regimens and also comes at significantly lower costs to patients. […] „The very high cost of therapy for acromegaly and frequent denial of effective treatments by insurance are barriers to attaining disease control in many patients,” says Bonert, the study’s senior and corresponding author. […] The goal of the research, published in the Journal of Clinical Endocrinology Metabolism, was to determine whether more cost-effective pairings of long-acting somatostatin analog medications and less-frequent doses of pegvisomant could normalize levels of insulin growth factor (IGF-1).

• #63 Breakthroughs in Treatment Dosing Increase Access to Life-Changing Medication for Acromegaly Patients | Cedars-Sinai

  https://www.cedars-sinai.org/blog/life-changing-medication-for-acromegaly-patients.html

  In the end, the dual aim to reduce cost and maintain treatment efficacy was achieved. […] Arm B, a low dose of somatostatin analogs with a weekly dose of 15-40 mg of pegvisomant, was shown to be the least expensive course of treatment (just under $10,000/month). […] Because of this important research conducted by Bonert and the Cedars-Sinai team, cost can start to become less of a factor and more patients will be able to pursue treatment options that will help them achieve optimal living. […] „The study shows that patients receiving high doses of this medication is mostly a waste of time and money. It is a point in favor of lower doses of pegvisomant, since even on the lowest possible doses, many patients maintained desired levels of IGF-1.”

• #64 Treatment of Acromegaly – Pituitary Foundation

  https://www.pituitary.org.uk/information/acromegaly-treatment/

  Octreotide and Lanreotide help the symptoms of acromegaly by reducing growth hormone levels into the target range of less than 1.8/2 ug/l in about half of patients. […] Pegvisomant is a blocker of the action of GH. […] Radiotherapy might be needed if not all the tumour could be removed in surgery or if it was not possible for you to have an operation. […] Once treatment is successful, you should notice that the soft tissue in your hands and feet decrease in size and patients often notice that their facial features gradually return towards normal.

• #65 Practical guidelines for diagnosis and treatment of acromegaly | Endocrinología y Nutrición (English Edition)

  https://www.elsevier.es/en-revista-endocrinologia-nutricion-412-articulo-practical-guidelines-for-diagnosis-treatment-S2173509313001670

  There are currently three drug classes that may potentially be used: SSAs, dopamine agonists, and peripheral GH antagonists (Grade A). […] Pegvisomant is the drug that best controls IGF-1 levels in acromegaly (Grade A), but its use is only currently approved in the event of SSA failure or when SSAs cannot be used because of their adverse effects.

• #66 Acromegaly – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/acromegaly/diagnosis-treatment/drc-20351226

  Radiation therapy destroys any leftover tumor cells after surgery to remove the tumor. It also slowly lowers the level of growth hormone. It may take months or years for radiation to improve acromegaly symptoms in ways that you notice. […] Types of radiation therapy include: […] Stereotactic radiosurgery uses 3D imaging to deliver a beam of high dose of radiation to the tumor cells. […] Proton beam radiation uses tiny particles called protons that point to the tumor. […] Conventional radiation therapy involves receiving small doses of radiation over 4 to 6 weeks.

• #67 Acromegaly – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/acromegaly/diagnosis-treatment/drc-20351226

  Radiation therapy destroys any leftover tumor cells after surgery to remove the tumor. It also slowly lowers the level of growth hormone. It may take months or years for radiation to improve acromegaly symptoms in ways that you notice. […] Types of radiation therapy include: […] Stereotactic radiosurgery uses 3D imaging to deliver a beam of high dose of radiation to the tumor cells. […] Proton beam radiation uses tiny particles called protons that point to the tumor. […] Conventional radiation therapy involves receiving small doses of radiation over 4 to 6 weeks.

• #68 Acromegaly Radiation Therapy | Expert Surgeon | Aaron Cohen-Gadol, MD

  https://www.aaroncohen-gadol.com/en/patients/acromegaly/treatment/radiation-therapy

  Radiation therapy is one potential treatment option that may be administered after surgery, or as the primary treatment if surgery is deemed too risky. […] In some cases, radiation therapy may be used after surgery to target and inhibit growth of any remaining tumor cells. […] Stereotactic radiosurgery can be used to deliver precise radiation to an adenoma (pituitary tumor), where the excess growth hormone is produced. […] Radiation can help to shrink the tumor and reduce the production of growth hormone, thereby alleviating the symptoms of acromegaly. […] Studies have found that radiation therapy causes the tumor size to decrease or stabilize in most patients, with most also experiencing a decrease in excessive growth hormone secretion over time. […] Radiation is generally used when the pituitary tumor responsible for symptoms cannot be removed completely by surgery or when surgery is not a viable option.

• #69 Acromegaly – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/acromegaly/diagnosis-treatment/drc-20351226

  Radiation therapy destroys any leftover tumor cells after surgery to remove the tumor. It also slowly lowers the level of growth hormone. It may take months or years for radiation to improve acromegaly symptoms in ways that you notice. […] Types of radiation therapy include: […] Stereotactic radiosurgery uses 3D imaging to deliver a beam of high dose of radiation to the tumor cells. […] Proton beam radiation uses tiny particles called protons that point to the tumor. […] Conventional radiation therapy involves receiving small doses of radiation over 4 to 6 weeks.

• #70 Acromegaly – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/acromegaly/diagnosis-treatment/drc-20351226

  Radiation therapy destroys any leftover tumor cells after surgery to remove the tumor. It also slowly lowers the level of growth hormone. It may take months or years for radiation to improve acromegaly symptoms in ways that you notice. […] Types of radiation therapy include: […] Stereotactic radiosurgery uses 3D imaging to deliver a beam of high dose of radiation to the tumor cells. […] Proton beam radiation uses tiny particles called protons that point to the tumor. […] Conventional radiation therapy involves receiving small doses of radiation over 4 to 6 weeks.

• #71

  https://www.jci.org/articles/view/39375

  Acromegaly treatment […] The latter include surgery, radiation, and use of novel medications. Somatostatin receptor (SSTR) ligands inhibit GH release, control tumor growth, and attenuate peripheral GH action, while GH receptor antagonists block GH action and effectively lower IGF1 levels. […] Several treatment options are currently available for acromegaly. […] Resection of GH-secreting pituitary adenomas is technically challenging because of the anatomic inaccessibility of the pituitary and bony sellar confines and the proximity of vital brain and vascular structures. […] Conventional external-beam radiotherapy is administered up to a maximum of 4000-5000 cGy in 180-cGy weekly doses spread over six weeks. […] The two forms of endogenous SRIF, comprising 14 or 28 aa, respectively, elicit cellular responses by five ubiquitously expressed SSTR receptor subtypes.

• #72 Acromegaly – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/acromegaly/diagnosis-treatment/drc-20351226

  Radiation therapy destroys any leftover tumor cells after surgery to remove the tumor. It also slowly lowers the level of growth hormone. It may take months or years for radiation to improve acromegaly symptoms in ways that you notice. […] Types of radiation therapy include: […] Stereotactic radiosurgery uses 3D imaging to deliver a beam of high dose of radiation to the tumor cells. […] Proton beam radiation uses tiny particles called protons that point to the tumor. […] Conventional radiation therapy involves receiving small doses of radiation over 4 to 6 weeks.

• #73 Acromegaly – Causes, Symptoms, TreatmentsSecond Opinion IconSecond Opinion IconGroup 9Group 49

  https://www.barrowneuro.org/condition/acromegaly/

  Most commonly caused by a noncancerous tumor of the pituitary gland (pituitary adenoma), acromegaly is often cured with surgery. Whether or not the entire tumor can be removed depends on its size and if it’s grown into nearby organ or tissue structures. […] The goal of acromegaly treatment is to control tumor size, normalize GH and IGF-1 levels, improve symptoms, and prevent complications. […] An operation by an experienced pituitary neurosurgeon is the first line of treatment and the only method for reaching a true cure for acromegaly. […] Treatment with prescription medication is possible if surgery does not cause remission in your acromegaly or if surgery is not recommended due to other reasons specific. […] Gamma Knife radiosurgery is a highly advanced form of accurate radiation therapy that achieves results similar to those in the surgical techniques described above. […] However, it can take several years for GH levels to return to normal using the Gamma Knife rather than the days or weeks with traditional surgery. As a result, Gamma Knife is often a last resort treatment for acromegaly after surgery and medications.

• #74 Acromegaly – Pituitary & Skull Base Tumor | UCLA Health

  https://www.uclahealth.org/medical-services/neurosurgery/pituitary-skull-base-tumor/conditions/pituitary-adenomas/acromegaly

  In recent years, the medical treatment of acromegaly has improved. In some cases, doctors use medication, and not surgery, as the first course of treatment. However, in many cases, patients require both medical and surgical therapies to control acromegaly. Medications include: Somatostatin analog (Octreotide, Lanreotide) injections, typically administered to patients on a monthly basis, suppress growth hormone production in about 70 percent of patients. Significant tumor shrinkage occurs in 30 to 50 percent of patients. Injections often improve symptoms of soft tissue swelling, headache, joint pains and sleep apnea. Patients require lifelong treatment with somatostatin. […] For some patients, surgery or medication is not sufficient to control the acromegaly. In these cases, doctors may recommend stereotactic radiosurgery. Stereotactic radiosurgery is a technique in which doctors aim a highly focused dose of radiation to the tumor. It takes an average of 18 months to lower the GH and IGF-1 levels.

• #75 Frontiers | Individualized acromegaly treatment: Is stereotactic radiation therapy changing the paradigm?

  https://www.frontiersin.org/articles/10.3389/fendo.2022.1034576/full

  Stereotactic radiosurgery is now a crucial armamentarium therapy and appears to be an effective and safe option for patients with acromegaly who have experienced unsuccessful surgery and have not responded to nor tolerated pharmaceutical agents. […] However, hypopituitarism is quite frequent and requires lifelong evaluation, as well as appropriate replacement therapy as hypopituitarism also increases mortality (28). […] Further advancements in radiotherapy may impact the treatment paradigm in the future. Nevertheless, radiotherapy remains a third-line treatment after surgery and medical therapy for most patients.

• #76 Acromegaly | Stanford Health Care

  https://stanfordhealthcare.org/medical-conditions/brain-and-nerves/acromegaly.html

  In selected patients, radiation therapy may be given as highly focused, single or multiple treatments. Radiation therapy may cause a gradual reduction of pituitary hormone levels, resulting in hypopituitarism. While there have been some reports of vision loss or brain injury, these are very rare complications of radiation treatments.

• #77 Acromegaly – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/acromegaly/diagnosis-treatment/drc-20351226

  Acromegaly treatment aims to improve symptoms and treat or prevent complications. The goal is to lower growth hormone and IGF-1 back to their proper levels and keep them there. […] To help lower your growth hormone (GH) and IGF-1 levels, treatment options often include: […] Surgery to remove the tumor that’s causing symptoms. Most often, this is the first treatment for acromegaly that’s caused by a pituitary gland tumor. […] Medicine to help lower hormone levels. This is usually an option if surgery doesn’t bring down growth hormone to the right level. […] Radiation to shrink the size of the tumor. Often, this a treatment choice if surgery isn’t an option. It’s also an option if surgery can’t remove the whole tumor or if medicine doesn’t help enough. […] Some people need a mix of these treatments. Your treatment plan depends on factors such as:

• #78 Precision Therapy in Acromegaly Caused by Pituitary Tumors: How Close Is It to Reality?

  https://www.e-enm.org/journal/view.php?doi=10.3803/EnM.2020.35.2.206

  However, cases of resistance to surgical or medical treatment require an integration of clinical and molecular predictors to aid in selecting the best tailored treatment. […] Surgical excision of pituitary adenomas in a transsphenoid surgery (TSS) has been the first-line treatment, being the only modality able to reduce morbidity and mortality and cause immediate hormonal normalization. […] If surgery is contraindicated or if the goals are not achieved, then medical therapy is resorted to, as there is a visible trend of decreasing use of radiotherapy over time, potentially due to extensively delayed remission. […] Multiple studies reported that radiotherapy (conventional and stereotactic radiosurgery) was applied as primary therapy at rates that range between 1% and 27%. […] Pharmacotherapy was prescribed as primary treatment in 2.5% to 45% of patients among the reviewed studies, while the majority was reserved for post-operative adjuvant treatment.

• #79 Faster Hormonal Control With Personalized Acromegaly Treatment Approach | MedPage Today

  https://www.medpagetoday.com/endocrinology/growthdisorders/111023

  A personalized treatment protocol was more effective for management of acromegaly — also known as gigantism — than the usual trial-and-error approach, the prospective ACROFAST trial indicated. […] When an individualized approach was crafted based on predictive biomarker testing, 78% of patients with acromegaly achieved hormonal control compared with 53% of traditionally-treated patients after a year (P=0.04), reported Joan Gil, PhD, of the Germans Trias i Pujol Research Institute in Badalona, Spain, and colleagues. […] Patients were over two times more likely to achieve hormonal control with the personalized approach after adjustment for age and sex (HR 2.53, 95% CI 1.30-4.80), they reported in the Journal of Clinical Endocrinology & Metabolism. […] „Our aim was to assist the physician in selecting the appropriate acromegaly course of care for each individual patient,” Gil told MedPage Today.

• #80 Faster Hormonal Control With Personalized Acromegaly Treatment Approach | MedPage Today

  https://www.medpagetoday.com/endocrinology/growthdisorders/111023

  „In order to discontinue this treatment using the trial-and-error method — current clinical practice — the patient must undergo a futile treatment for 6 to 9 months after likely a delay of many years in diagnosis,” said Gil. […] By taking this more personalized approach, it can help in discarding octreotide/lanreotide in individuals who won’t respond to this medication. […] Gil added that as more acromegaly treatments emerge in the coming years, the trial-and-error method will „no longer be viable.” […] This method also was favored at the 6-month mark (69% controlled vs 47%, P=0.07), and patients achieved faster hormonal control with the personalized approached (320 days vs 365 days, P=0.010). […] „We want the clinicians to be aware of how simple it is to apply individualized treatment in acromegaly,” said Gil.

• #81 Faster Hormonal Control With Personalized Acromegaly Treatment Approach | MedPage Today

  https://www.medpagetoday.com/endocrinology/growthdisorders/111023

  A personalized treatment protocol was more effective for management of acromegaly — also known as gigantism — than the usual trial-and-error approach, the prospective ACROFAST trial indicated. […] When an individualized approach was crafted based on predictive biomarker testing, 78% of patients with acromegaly achieved hormonal control compared with 53% of traditionally-treated patients after a year (P=0.04), reported Joan Gil, PhD, of the Germans Trias i Pujol Research Institute in Badalona, Spain, and colleagues. […] Patients were over two times more likely to achieve hormonal control with the personalized approach after adjustment for age and sex (HR 2.53, 95% CI 1.30-4.80), they reported in the Journal of Clinical Endocrinology & Metabolism. […] „Our aim was to assist the physician in selecting the appropriate acromegaly course of care for each individual patient,” Gil told MedPage Today.

• #82 Practical guidelines for diagnosis and treatment of acromegaly | Endocrinología y Nutrición (English Edition)

  https://www.elsevier.es/en-revista-endocrinologia-nutricion-412-articulo-practical-guidelines-for-diagnosis-treatment-S2173509313001670

  Three treatment modalities currently exist: surgery, medical treatment, and radiotherapy. […] Surgery continues to be the treatment of choice for acromegaly in most patients (Grade B), although advances in medical treatment in recent years have changed the treatment sequence. […] Radiotherapy is currently the last step in the treatment scheme, being reserved for patients not controlled after initial medical or surgical treatment and for uncontrolled, invasive macroadenomas (Grade C). […] It is important that patients are cared for by a multidisciplinary team consisting of experienced endocrinologists, neurosurgeons, and radiation therapists able to recommend the most adequate treatment in each case (Grade C). […] Medical treatment of acromegaly may be prescribed as follows: 1. As primary treatment for patients who have a significant surgical risk, in those with a low chance of cure because the tumor has extrasellar extension, without chiasm compression, and in patients who refuse surgery and choose medical treatment (Grade C). 2. As supplemental treatment after surgery failure or in the interim period until radiotherapy becomes effective (Grade B). 3. It may also be prescribed as pre-treatment before surgery to improve the anesthetic conditions in the patients or the results of surgery itself, or in patients in whom surgery is delayed.

• #83 Updates in Diagnosis and Treatment of Acromegaly | [current-page:pager]touchENDOCRINOLOGY

  https://touchendocrinology.com/pituitary/journal-articles/updates-in-diagnosis-and-treatment-of-acromegaly/

  Radiation therapy remains third in line in the treatment algorithm for acromegaly, and is usually considered in cases of large residual (or enlarging) tumour following surgery, and if medical therapy is unsuccessful or not tolerated. […] The treatment of acromegaly remains multimodal for most patients and a multidisciplinary team is essential for optimal disease management and outcome.

• #84 Acromegaly – Pituitary & Skull Base Tumor | UCLA Health

  https://www.uclahealth.org/medical-services/neurosurgery/pituitary-skull-base-tumor/conditions/pituitary-adenomas/acromegaly

  In recent years, the medical treatment of acromegaly has improved. In some cases, doctors use medication, and not surgery, as the first course of treatment. However, in many cases, patients require both medical and surgical therapies to control acromegaly. Medications include: Somatostatin analog (Octreotide, Lanreotide) injections, typically administered to patients on a monthly basis, suppress growth hormone production in about 70 percent of patients. Significant tumor shrinkage occurs in 30 to 50 percent of patients. Injections often improve symptoms of soft tissue swelling, headache, joint pains and sleep apnea. Patients require lifelong treatment with somatostatin. […] For some patients, surgery or medication is not sufficient to control the acromegaly. In these cases, doctors may recommend stereotactic radiosurgery. Stereotactic radiosurgery is a technique in which doctors aim a highly focused dose of radiation to the tumor. It takes an average of 18 months to lower the GH and IGF-1 levels.

• #85 Acromegaly

  https://www.nhs.uk/conditions/acromegaly/

  Treatments for acromegaly can include: surgery to remove the tumour […] radiotherapy to target the tumour and reduce growth hormone levels […] injections or tablets to reduce growth hormone levels. Treatment usually stops your body producing too much growth hormone and usually improves your symptoms. After treatment, you’ll continue to have appointments with a specialist. They can monitor how well your pituitary gland is working and check that your treatment is right for you.

• #86 Acromegaly: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/article/000321.htm

  Surgery to remove the pituitary tumor that is causing this condition often corrects the abnormal GH. Sometimes, the tumor is too large to be removed completely and acromegaly is not cured. In this case, medicines and radiation (radiotherapy) may be used to treat acromegaly. […] Some people with tumors that are too complicated to remove by surgery are treated with medicines instead of surgery. These medicines may block the production of GH from the pituitary gland or prevent the action of GH in other parts of the body. […] After treatment, you will need to see your provider regularly to make sure that the pituitary gland is working normally and that acromegaly does not come back. Yearly evaluations are usually recommended.

• #87 Acromegaly | UVA Health

  https://uvahealth.com/services/benign-brain-tumor/acromegaly

  Once your surgeon removes the tumor, the imbalance of IGF and GH hormone returns to normal; this may take several months. […] Many acromegaly symptoms improve, and you can eventually sleep better and discontinue taking medications for diabetes and high blood pressure. This usually takes weeks to months. […] Radiotherapy is most often performed after surgery has removed the majority of the tumor, but some tumor remains. […] Because any type of pituitary tumor may recur, regular follow up with blood tests is necessary. If a recurrent tumor is found, additional treatment is necessary.

• #88 Acromegaly – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/acromegaly/diagnosis-treatment/drc-20351226

  It’s common for some changes in physical features to improve with treatment. For example, swelling of soft tissue often goes down. And the skin often becomes less oily and coarse. But enlarged bones don’t return to the size that they used to be. […] If you also have other health conditions due to acromegaly, you may need other treatments to manage them. […] Removing the tumor often returns growth hormone to the right level, especially if the tumor is small. […] Sometimes, surgeons can’t remove the whole tumor. When this happens, the level of growth hormone may still be too high after surgery. Another surgery, medicines or radiation treatments may be needed. […] Medicine can help lower hormone levels or block the hormones’ effects. Your healthcare professional may recommend one or more of the following:

• #89 Acromegaly – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/acromegaly/diagnosis-treatment/drc-20351226

  It’s common for some changes in physical features to improve with treatment. For example, swelling of soft tissue often goes down. And the skin often becomes less oily and coarse. But enlarged bones don’t return to the size that they used to be. […] If you also have other health conditions due to acromegaly, you may need other treatments to manage them. […] Removing the tumor often returns growth hormone to the right level, especially if the tumor is small. […] Sometimes, surgeons can’t remove the whole tumor. When this happens, the level of growth hormone may still be too high after surgery. Another surgery, medicines or radiation treatments may be needed. […] Medicine can help lower hormone levels or block the hormones’ effects. Your healthcare professional may recommend one or more of the following:

• #90 Treatment of Acromegaly – Pituitary Foundation

  https://www.pituitary.org.uk/information/acromegaly-treatment/

  Octreotide and Lanreotide help the symptoms of acromegaly by reducing growth hormone levels into the target range of less than 1.8/2 ug/l in about half of patients. […] Pegvisomant is a blocker of the action of GH. […] Radiotherapy might be needed if not all the tumour could be removed in surgery or if it was not possible for you to have an operation. […] Once treatment is successful, you should notice that the soft tissue in your hands and feet decrease in size and patients often notice that their facial features gradually return towards normal.

• #91 Treatment of acromegaly – UpToDate

  https://www.uptodate.com/contents/treatment-of-acromegaly

  In addition to lowering IGF-1, another biochemical goal is to lower the serum growth hormone (GH) concentration to <1 mcg/L as measured by immunoradiometric or chemiluminescent assay, as this also correlates with control of acromegaly. However, the IGF-1 criterion may be better since some patients who appear to have active disease clinically and by elevated IGF-1 concentration have serum GH values that suppress to <1 mcg/L. Serum IGF-1 concentrations also correlate better than serum GH with insulin sensitivity in patients with acromegaly. [...] When serum GH and IGF-1 concentrations decline to normal, the characteristic soft tissue overgrowth and related symptoms gradually recede and the metabolic abnormalities, such as diabetes mellitus, improve. In addition, life expectancy returns to that of the general population. However, bony abnormalities generally do not regress and joint symptoms persist.

• #92

  https://link.springer.com/article/10.1007/s11102-012-0420-x

  In March 2011, the Acromegaly Consensus Group met to revise and update the guidelines on the diagnosis and treatment of acromegaly complications. […] The diagnosis and management of complications of disease are therefore critical for assuring a favorable long-term outcome for this chronic illness. Current comorbidity issues were discussed by the group and recommendations made for updating the 2003 guidelines. […] Hypertension is highly prevalent, occurring in more than 40 % of patients with acromegaly, and early diagnosis and early aggressive treatment of elevated blood pressure is important irrespective of which acromegaly treatment is employed. […] Treatment of acromegaly improves early and intermediate stage myocardial hypertrophy and cardiac dysfunction. […] Improvement depends on age, presence of hypertension and duration of the disease.

• #93 Treatment of acromegaly – UpToDate

  https://www.uptodate.com/contents/treatment-of-acromegaly

  In addition to lowering IGF-1, another biochemical goal is to lower the serum growth hormone (GH) concentration to <1 mcg/L as measured by immunoradiometric or chemiluminescent assay, as this also correlates with control of acromegaly. However, the IGF-1 criterion may be better since some patients who appear to have active disease clinically and by elevated IGF-1 concentration have serum GH values that suppress to <1 mcg/L. Serum IGF-1 concentrations also correlate better than serum GH with insulin sensitivity in patients with acromegaly. [...] When serum GH and IGF-1 concentrations decline to normal, the characteristic soft tissue overgrowth and related symptoms gradually recede and the metabolic abnormalities, such as diabetes mellitus, improve. In addition, life expectancy returns to that of the general population. However, bony abnormalities generally do not regress and joint symptoms persist.

• #94 Acromegaly – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/acromegaly/diagnosis-treatment/drc-20351226

  It’s common for some changes in physical features to improve with treatment. For example, swelling of soft tissue often goes down. And the skin often becomes less oily and coarse. But enlarged bones don’t return to the size that they used to be. […] If you also have other health conditions due to acromegaly, you may need other treatments to manage them. […] Removing the tumor often returns growth hormone to the right level, especially if the tumor is small. […] Sometimes, surgeons can’t remove the whole tumor. When this happens, the level of growth hormone may still be too high after surgery. Another surgery, medicines or radiation treatments may be needed. […] Medicine can help lower hormone levels or block the hormones’ effects. Your healthcare professional may recommend one or more of the following:

• #95

  https://myhealth.alberta.ca/Health/aftercareinformation/pages/conditions.aspx?hwid=ut2956

  Acromegaly is often caused by a tumour of the pituitary gland, which is where growth hormone is made. But the tumour isn’t cancer. It can be treated with medicine, surgery, radiation treatment, or some combination of these. […] Treatment may stop some abnormal growth, but bones don’t go back to normal after the treatment.

• #96 Acromegaly | Brain Institute | OHSU

  https://www.ohsu.edu/brain-institute/acromegaly

  Dr. Maria Fleseriu is one of the worlds leading experts on acromegaly. Her extensive research has led to new medications and other treatment improvements. […] People across the United States turn to the OHSU Pituitary Center for expert acromegaly treatment. […] We stress both medical success and your well-being in our treatment, based on our own research. […] Our work in clinical trials helped lead to FDA approval for a new acromegaly medication. […] Treatment can reduce the risk of complications as well as improve symptoms and quality of life. Treatment that returns GH levels to normal gives patients a regular life expectancy. […] Surgery to remove the tumor is often the first step. You also may need medication and radiation therapy. Your care team will work with you to develop a treatment plan that best meets your needs.

• #97 Acromegaly Symptoms, Diagnosis, Treatment, Patient Resources

  https://crinetics.com/acromegaly-symptoms-diagnosis-treatment-resources-2/

  The PATHFNDR studies are randomized, placebo-controlled, multi-center studies to evaluate the safety and efficacy of ONCE-DAILY, ORAL paltusotine in subjects with acromegaly. […] Paltusotine is the first once-daily, oral, selectively-targeted somatostatin receptor type 2 agonist in development for the proposed treatment of people with acromegaly. […] Currently available pharmacological interventions for the treatment of acromegaly can reduce a patient’s risk of complications and significantly improve characteristics of the condition. […] At the time of detection, two-thirds of cases are macroadenomas. This may relate to diagnostic delays and poses challenges in the surgical management of these tumors. An endoscopic transsphenoidal resection of the tumor often reverses vision problems and restores normal hormone balance.

• #98 Breakthroughs in Treatment Dosing Increase Access to Life-Changing Medication for Acromegaly Patients | Cedars-Sinai

  https://www.cedars-sinai.org/blog/life-changing-medication-for-acromegaly-patients.html

  Life-changing medication for acromegaly patients. […] For many patients with acromegaly, medications are the primary treatment strategy to control the disease. […] New research at the Cedars-Sinai Pituitary Center demonstrates that smaller doses of pegvisomant in combination with low-dose, long-acting somatostatin analog medications are equally effective at treating acromegaly as existing higher-dose treatment regimens and also comes at significantly lower costs to patients. […] „The very high cost of therapy for acromegaly and frequent denial of effective treatments by insurance are barriers to attaining disease control in many patients,” says Bonert, the study’s senior and corresponding author. […] The goal of the research, published in the Journal of Clinical Endocrinology Metabolism, was to determine whether more cost-effective pairings of long-acting somatostatin analog medications and less-frequent doses of pegvisomant could normalize levels of insulin growth factor (IGF-1).

• #99

  https://www.jci.org/articles/view/39375

  Pegvisomant is a 199-aa recombinant competitive GH antagonist mutated at Gly120Arg. […] In 177 patients receiving daily pegvisomant doses of 10-30 mg, 76% achieved normal IGF1 levels after 24 months, with improvement of symptoms, including soft-tissue swelling, perspiration, cardiomyopathy, and heart failure. […] Novel GHR antagonists in development include small orally active molecules, recombinant GH antagonists, GHR antibodies, and antisense molecules directed against the GHR.

• #100 Faster Hormonal Control With Personalized Acromegaly Treatment Approach | MedPage Today

  https://www.medpagetoday.com/endocrinology/growthdisorders/111023

  „In order to discontinue this treatment using the trial-and-error method — current clinical practice — the patient must undergo a futile treatment for 6 to 9 months after likely a delay of many years in diagnosis,” said Gil. […] By taking this more personalized approach, it can help in discarding octreotide/lanreotide in individuals who won’t respond to this medication. […] Gil added that as more acromegaly treatments emerge in the coming years, the trial-and-error method will „no longer be viable.” […] This method also was favored at the 6-month mark (69% controlled vs 47%, P=0.07), and patients achieved faster hormonal control with the personalized approached (320 days vs 365 days, P=0.010). […] „We want the clinicians to be aware of how simple it is to apply individualized treatment in acromegaly,” said Gil.

• #101 Acromegaly | Brain Institute | OHSU

  https://www.ohsu.edu/brain-institute/acromegaly

  Long-term monitoring is also important. The hormonal imbalance caused by acromegaly can put you at risk for heart problems, colon growths and other conditions. […] If your surgeon can remove the tumor completely, you may not need any other treatments. […] We often use a minimally invasive technique called transsphenoidal surgery to remove the tumor through the nose. […] We will work with you to find the right medication and dose, and to manage any side effects. […] Medications may include: Somatostatin receptor ligands, Growth hormone receptor antagonists, Dopamine agonists. […] In these cases, we may recommend radiation therapy. […] Radiation treatment is usually followed by medication to slow tumor growth and to control GH levels. […] We are part of the OHSU Brain Institute, a national leader in offering clinical trials to test new treatment approaches.

• #102 Management of acromegaly

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2990454/

  Dopamine agonists have been used for the management of acromegaly for more than 30 years but low efficacy has discouraged their adoption as monotherapy. […] Radiotherapy can be employed as third- or second-line treatment in patients with persistent or recurrent tumors after surgery and who are resistant or intolerant to pharmacological agents. […] The combined use of the different treatment approaches allows for attaining disease control or even complete cure in an increasing proportion of patients.

• #103 Gigantism and Acromegaly Treatment & Management: Approach Considerations, Pharmacologic Therapy, Transsphenoidal Surgery

  https://emedicine.medscape.com/article/925446-treatment

  Tests of pegvisomant (Somavert), a novel hepatic GH-receptor antagonist, demonstrated effective suppression of GH and IGF-I levels in patients with acromegaly due to pituitary tumors or ectopic GHRH hypersecretion. […] Radiation therapy is recommended if GH hypersecretion is not normalized with surgery. […] Transsphenoidal surgery as the primary therapy in most patients. […] The primary goal of surgery is to normalize GH levels. […] If surgery does not normalize GH secretion, options include pituitary radiation and medical therapy. […] In a majority of cases of acromegaly, multimodal treatment with surgery, medical therapy, and radiotherapy provides biochemical control as defined by Endocrine Society guidelines. […] Patients should also be evaluated for severe GH deficiency, which may occur in more than half of all patients treated for acromegaly.

• #104

  https://link.springer.com/article/10.1007/s11102-024-01397-w

  However, some patients are kept on this treatment despite inadequate control suggesting that cost-effectiveness, availability, patient preference, side effects, and therapeutic inertia may play a possible role also in PTCOE. […] Moreover, at odds with consensus guidelines, other monotherapies for acromegaly appear to have a marginal role as compared to combination therapies as extrapolated from PTCOE practice data. […] Presence of uncontrolled patients in each treatment category suggest that further optimization of medical therapy, as well as use of other therapeutic tools such as radiosurgery may be needed. […] According to current consensus guidelines, the first treatment option remains surgery, which may provide immediate biochemical remission, particularly in the infrequent instance of microadenoma.

• #105 Frontiers | Individualized acromegaly treatment: Is stereotactic radiation therapy changing the paradigm?

  https://www.frontiersin.org/articles/10.3389/fendo.2022.1034576/full

  Stereotactic radiosurgery is now a crucial armamentarium therapy and appears to be an effective and safe option for patients with acromegaly who have experienced unsuccessful surgery and have not responded to nor tolerated pharmaceutical agents. […] However, hypopituitarism is quite frequent and requires lifelong evaluation, as well as appropriate replacement therapy as hypopituitarism also increases mortality (28). […] Further advancements in radiotherapy may impact the treatment paradigm in the future. Nevertheless, radiotherapy remains a third-line treatment after surgery and medical therapy for most patients.

• #106 Updates in Diagnosis and Treatment of Acromegaly | [current-page:pager]touchENDOCRINOLOGY

  https://touchendocrinology.com/pituitary/journal-articles/updates-in-diagnosis-and-treatment-of-acromegaly/

  Radiation therapy remains third in line in the treatment algorithm for acromegaly, and is usually considered in cases of large residual (or enlarging) tumour following surgery, and if medical therapy is unsuccessful or not tolerated. […] The treatment of acromegaly remains multimodal for most patients and a multidisciplinary team is essential for optimal disease management and outcome.

• #107 Acromegaly – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/acromegaly/symptoms-causes/syc-20351222

  Without treatment, acromegaly can lead to other serious and sometimes life-threatening health conditions called complications. But treatments such as surgery, medicine and radiation can lower the risk of complications. Treatment also can improve many acromegaly symptoms. […] Early treatment of acromegaly can prevent these complications or keep them from becoming worse. Without treatment, acromegaly and its complications can lead to early death.

• #108 Precision Therapy in Acromegaly Caused by Pituitary Tumors: How Close Is It to Reality?

  https://www.e-enm.org/journal/view.php?doi=10.3803/EnM.2020.35.2.206

  Acromegaly presents with an enigmatic range of symptoms and comorbidities caused by chronic and progressive growth hormone elevations, commonly due to endocrinologic hypersecretion from a pituitary gland tumor. […] Assessment of current and novel predictors of responsiveness to distinct therapy can lead to multilevel categorization of patients, allowing integration into new clinical guidelines and reduction of increased morbidity and mortality associated with acromegaly. […] Surgery, acting as first line, followed by medical therapy (somatostatin analogues [SSAs], GH receptor antagonists, and dopamine agonists [DAs]), radiotherapy, radiosurgery (gamma knife surgery), and different combinations of each have been shown to result in a decrease in morbidity and mortality to general population.

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