Pharmacological basis for the treatment of acromegaly

Acromegaly is a rare acquired disease characterized by hypersecretion of Growth Hormone (GH) that leads to body progressive disfigurement together with several systemic manifestations. Its source is a pituitary adenoma with pure GH secretion (60%) or mixed secretion of different hormones, though on rare occasions it is due to ectopic secretion of GH-releasing hormone. It is usually diagnosed late in mid-aged adults and affects both genders equally. The treatment objective is to correct (or prevent) tumour compression by surgical extirpation of the tumour mass and to reduce serum GH and Insulin-like Growth Factor type I (IGF-I) concentrations to normal levels. The first line of treatment is usually transsphenoidal surgery and in some cases Somatostatin Analogues (SA) may be useful. When surgery is not possible or does not achieve adequate hormonal control, pharmacological treatment with SA and/or radiation therapy can be applied. If the response is not satisfactory, treatment can be optimized by modifying the SA dosage or administration interval, or treatment can be switched to monotherapy with a GH receptor antagonist, pegvisomant, or other forms of combination therapy can be selected. Proper hormonal control is achieved in the majority of patients, allowing for a life expectancy that is similar to the general population, though in many cases there are sequelae such as joint pain, body deformity and changes in quality of life