Medical treatment of acromegaly with dopaminergic agents

: The medical treatment of acromegaly with dopaminergic drugs has its physiopathological premise in the observation that agents capable of stimulating dopaminergic receptors directly are capable of determining GH secretion inhibition in a large percentage of acromegalic patients. Chronic administration of 5-20 mg/die of bromocryptin, long acting dopaminergic agonist, leads to a stable reduction in the levels of GH and somatomedin C (SmC) in about 50% of patients. However, these are only normalised in 20%. Treatment induces marked improvement in the clinical and metabolic changes typical of acromegalic disease. The therapeutic effect of dopaminergics may be maintained for periods of treatment lasting years but upon suspension of treatment pH levels return quickly to pretreatment levels. The antitumoral effect of the dopaminergic frequently encountered in prolactinomas is a rarer event in acromegaly and occurs more readily in patients with mixed secreting GH and PRL tumours than in pure GH. Currently octractide, a long lasting somatostatin analogue, is the most effective drug in the medical treatment of acromegaly; however the dopaminergic agonists remain a valid alternative.