Clinical importance of achieving biochemical control with medical therapy in adult patients with acromegaly

Abstract

In acromegaly, achieving biochemical control (growth hormone [GH] level <1.0 ng/mL and age- and sex-normalized levels of insulin-like growth factor 1 [IGF-1]) through timely diagnosis and appropriate treatment provides an opportunity to improve patient outcomes. Diagnosis of acromegaly is challenging because it is rooted in observing subtle clinical manifestations, and it is typical for acromegaly to evolve for up to 10 years before it is recognized. This results in chronic exposure to elevated levels of GH and IGF-1 and delay in patients receiving appropriate treatment, which consequently increases mortality risk. In this review, the clinical impact of elevated GH and IGF-1 levels, the effectiveness of current therapies, and the potential role of novel treatments for acromegaly will be discussed. Clinical burden of acromegaly and benefits associated with management of GH and IGF-1 levels will be reviewed. Major treatment paradigms in acromegaly include surgery, medical therapy, and radiotherapy. With medical therapies, such as somatostatin analogs, dopamine agonists, and GH receptor antagonists, a substantial proportion of patients achieve reduced GH and normalized IGF-1 levels. In addition, signs and symptoms, quality of life, and comorbidities have also been reported to improve to varying degrees in patients who achieve biochemical control. Currently, there are several innovative therapies in development to improve patient outcomes, patient use, and access. Timely biochemical control of acromegaly ensures that the patient can ultimately improve morbidity and mortality from this disease and its extensive consequences.

<p>Octreotide-Resistant Acromegaly: Challenges and Solutions</p>

“…1,2 The incidence is approximately 3 cases per 1 million persons per year, though more recent estimates report an increased incidence (about 11 per million person-years). [3][4][5][6] As far as prevalence, some studies estimate that the disease affects 40-70 patients per million of the general population, or even more (86-240 per million). 7,8 Comorbidities and mortality risk in acromegalic patients are related to time of exposure to GH and IGF-1 excess.…”

Association between biochemical control and comorbidities in patients with acromegaly: an Italian longitudinal retrospective chart review study

“…Moreover, levels of IGF-1 and GH are subject to influences by other factors, including patient's diet, sleep and exercise patterns, systemic illness, and concurrent medications [7]. While the majority of patients achieve sustained biochemical control over time when receiving treatment, the pace at which biochemical levels normalize varies for each patient, and a considerable proportion of patients never reach biochemical control [9,10]. Therefore, relying on IGF-1 and GH measurements from one single point in time may be inaccurate as this may be insufficiently representative of the patient's true biochemical control status.…”

Somatostatin receptors in normal and acromegalic somatotroph cells: the U-turn of the clinician to immunohistochemistry report – a review

“…Increased pituitary-released GH and secondary hepatic insulin-like growth factor-1 (IGF-1) elevation cause metabolic anomalies, with high rate of morbidity and mortality, and associated cost-effectiveness of therapy [1,[32][33][34]. These are the main reasons of continuous seeking to achieve disease control through adequate medical and surgical management [35]. Tissular studies showed an overexpression of GH and its receptor plays an oncogenic role, one of the reasons to try control GH excess [36].…”

“…Medical therapy is the first line of approach after unsuccessful transsphenoidal hypophysectomy [35,37,38]. In Figure 5 (A-C), we introduce a postoperatory pituitary imagery aspect in an adult female with acromegaly (a priory unpublished case).…”