Comprehensive management of acromegaly

Abstract

The somatostatin analog octreotide has a defined role in the overall management strategy for patients with acromegaly. Octreotide is effective in managing acromegaly both as an adjuvant to surgery and as a primary therapy. Octreotide is also beneficial to radiotherapy-treated patients in that the drug suppresses growth hormone (GH) secretion until the long-term ablative effects of radiation occur. Older patients, those with microadenomas, and those with systemic sequelae of hypersomatatropism benefit from initial primary medical therapy with octreotide. In these patients, the almost invariable biochemical normalization achieved by octreotide therapy renders it an effective alternative to surgery. Complications associated with octreotide are minor in comparison to the benefits, but the requirement for multiple daily injections is currently a major drawback. Approximately 25% of octreotide-treated acromegaly patients develop asymptomatic gallstones or sludge that require no treatment. The impact of sustained attenuation of GH and insulin-like growth factor-I (IGF-I) levels by octreotide on the pathogenesis of the long-term sequelae of hypersomatatropism can now be prospectively evaluated. Novel longer-acting octreotide-delivery mechanisms and new-generation somatostatin analogs will provide further advantages for primary pharmacotherapy in acromegaly.