The last decades have seen important advances in the fields of neuroendocrinology, cell biology, clinical chemistry, drug development, imaging, neurosurgery and radiotherapy, all of which have brought benefits to the management of acromegaly. The merits of GH and insulin-like growth factor (IGF)-I measurements in the diagnosis and in the assessment of therapeutic outcomes of acromegaly have been intensively studied. The biochemical targets that for treatment are a normal, age-adjusted IGF-I and a random GH <1 ng/mL using sensitive specific two site assays.
Three classes of drugs offer therapeutic options for acromegaly: dopamine agonists, somatostatin analogues and GH receptor antagonist. Dopamine agonists have a limited adjunctive role in disease control. Somatostatin analogues, octreotide and lanreotide have gained a firm place in drug therapy, controlling hypersecretion and tumour growth in over 50-60% of patients. A new generation somatostatin analogue (pasireotide) that targets a wider spectrum of somatostatin receptor subtypes holds potential of greater efficacy for acromegaly. Pegvisomant, a GH receptor antagonist normalizes IGF-1 in nearly all patients but does not control tumour growth.
Surgery remains primary therapy for small resectable tumours. where the chance of cure is high. For large or invasive tumours where the prospect of surgical cure is remote, first-line therapy is somatostatin analogue treatment with debulking surgery having an adjunctive role to achieve tight control or to alleviate compression of the optic chiasm.
Radiotherapy remains important adjuvant treatment where other modes are contraindicated or have failed. Compared to conventional external beam therapy, sterotactic radiosurgery reduces treatment time and the risk of radiation damage.
Acromegaly remains a challenging disease to manage. However the expanding range of therapeutic options has brought better outcomes for patients and offers the potential to tailor therapy based on a patient’s individual requirements