Medical Therapy in Patients with Acromegaly: Predictors of Response and Comparison of Efficacy of Dopamine Agonists and Somatostatin Analogues

Sherlock, Mark; Fernández-Rodríguez, E.; Alonso, Aurora Aragon; Reulen, Raoul C.; Ayuk, John; Clayton, R. N.; Holder, G.; Sheppard, M. C.; Bates, Andrew; Stewart, Paul M.

doi:10.1210/jc.2008-1420

Cited by 67 publications

(48 citation statements)

References 55 publications

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“…Treatment for acromegaly aims at decreasing hormone levels, ameliorating patients' manifestations, and decreasing the local compressive effects of the pituitary adenoma. Surgical treatment remains the first management option for virtually all acromegalic patients, unless the patients refuse to undergo or are too ill to undergo a surgical procedure or prefer the medical option to an operation (6,8,17,18,19,20,21). In agreement with Andersen et al (22), we found that a large proportion were females (57.7%) in GHCPRL group, but no significant difference in sex was observed between the two groups.…”

Section: Discussionsupporting

confidence: 91%

The characteristics of acromegalic patients with hyperprolactinemia and the differences in patients with merely GH-secreting adenomas: clinical analysis of 279 cases

Wang

Mou²,

Jiang³

et al. 2012

European Journal of Endocrinology

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Objective: The aim of this study is to evaluate clinical data from a large cohort of acromegalic patients with and without hyperprolactinemia. Design and methods: Between January 2002 and June 2010, a set of data on 279 acromegalic patients undergoing transsphenoidal surgery was available. Based on preoperative GH and prolactin (PRL) levels, patients were divided into GH and GHCPRL groups. A stabilization or a further improvement of postoperative changes in clinical, hormonal, immunohistochemical, and magnetic resonance imaging parameters was observed in all patients throughout the follow-up period. Results: The GH group had significantly more coarse facial features, large hands and feet, hypertension, and diabetes mellitus compared with the GHCPRL group but significantly less menstrual disorders (13.8 vs 54.3%, P!0.001) and galactorrhea (3.1 vs 22.4%, P!0.001). The GH group had a higher age at diagnosis compared with the GHCPRL group (45.6G13.9 vs 40.4G11.4 years, PZ0.001). The GH group had a smaller mean maximal diameter of the adenomas (2.2G0.9 vs 2.6G1.1 cm, PZ0.004). There were no significant correlations between hormone levels and the immunohistochemical results. According to the criteria for hormonal cure of acromegaly, the surgical control rates in the GH and GHCPRL groups were 68.4 and 59.7% respectively (PZ0.187). Tumor size was an important factor that affected the results of the operations. The rates of surgical control in GH and GHCPRL groups were 80.7 and 69.1% respectively (PZ0.037), and the recurrence rates in the two groups were 7.1 and 11.3% respectively (PZ0.185). Conclusions: Compared with patients with merely GH-secreting adenomas, acromegalic patients with hyperprolactinemia are characterized by an earlier onset of disease, lesser acromegalic features, lower GH levels, but larger tumor sizes, whereas in female patients, GH-PRL secreting adenomas are associated with higher incidences of menstrual disorders and galactorrhea.

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Section: Discussionsupporting

confidence: 91%

The characteristics of acromegalic patients with hyperprolactinemia and the differences in patients with merely GH-secreting adenomas: clinical analysis of 279 cases

Wang

Mou²,

Jiang³

et al. 2012

European Journal of Endocrinology

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“…Bulgarian patients had access only to DAs (bromocriptine and cabergoline) known for their lower efficacy in acromegaly (36,37). The lack of SSAs and GHRAs and the poorer efficacy of DAs are the most possible explanation for the significantly higher rates of other treatment options, such as neurosurgical interventions and radiotherapy.…”

Section: Clinical Studymentioning

confidence: 99%

Could different treatment approaches in acromegaly influence life expectancy? A comparative study between Bulgaria and Campania (Italy)

Colao

Vandeva

Pivonello

et al. 2014

European Journal of Endocrinology

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Background: Mortality in acromegaly strictly depends on optimal control of GH and IGF1 levels. Modern medical therapy with somatostatin analogs (SSAs) and GH receptor antagonists (GHRAs) is not available in many countries due to funding restrictions. This retrospective, comparative, cohort study investigated the impact of different treatment modalities on disease control (GH and IGF1) and mortality in acromegaly patients. Methods: Two cohorts of patients with acromegaly from Bulgaria (nZ407) and Campania, Italy (nZ220), were compared, and mortality rates were evaluated during a 10-year period (1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008). Results: The major difference in treatment approach between cohorts was the higher utilization of SSAs and GHRAs in Italy, leading to a decreased requirement for radiotherapy. Significantly more Italian than Bulgarian patients had achieved disease control (50.1 vs 39.1%, PZ0.005) at the last follow-up. Compared with the general population, the Bulgarian cohort had a decreased life expectancy with a standardized mortality ratio (SMR) of 2.0 (95% CI 1.54-2.47) that was restored to normal in patients with disease control -SMR 1.25 (95% CI 0.68-1.81). Irradiated patients had a higher cerebrovascular mortality -SMR 7.15 (95% CI 2.92-11.37). Internal analysis revealed an independent role of age at diagnosis and last GH value on all-cause mortality and radiotherapy on cerebrovascular mortality. Normal survival rates were observed in the Italian cohort: SMR 0.66 (95% CI 0.27-1.36). Conclusions: Suboptimal biochemical control was associated with a higher mortality in the Bulgarian cohort. Modern treatment options that induce a strict biochemical control and reduce the necessity of radiotherapy might influence the life expectancy. Other factors, possibly management of comorbidities, could contribute to survival rates.

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“…Considering the above evidence, SSAs have greater efficacy in terms of both tumor shrinkage and biochemical control in comparison with CAB and are, therefore, recommended as the first choice medical therapy for the treatment of acromegaly patients not cured by surgery [1,21]. In addition, a much better experience is reported in the literature when using SSA with respect to efficacy and long-term results [1,2,21].…”

Section: Cab As An Adjuvant Therapymentioning

confidence: 99%

“…In addition, a much better experience is reported in the literature when using SSA with respect to efficacy and long-term results [1,2,21]. Exceptions are the cases of mildly elevated GH and IGF-I levels and those of prolactin co-secretion (*30 % of the tumors) when CAB monotherapy may have a better efficacy than the SSA, and therefore, can be considered as the first option of therapy [3,15].…”

Section: Cab As An Adjuvant Therapymentioning

confidence: 99%

Cabergoline treatment in acromegaly: cons

Kasuki

Neto

2014

Endocrine

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Many options are available for the treatment of acromegaly, including surgery, radiotherapy, and medical treatment. Cabergoline (CAB), a dopamine agonist with high affinity for dopamine receptor type 2, has been used both in monotherapy and in conjunction with somatostatin analogs (SSAs). Although it is administered orally and has a relatively lower-cost in comparison with SSAs, few studies have demonstrated its usefulness, there is a lack of randomized-controlled trials and other drugs (SSAs and pegvisomant) with more data in the literature are available; these issues are the main drawbacks of adopting CAB for the treatment of acromegaly.

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Medical Therapy in Patients with Acromegaly: Predictors of Response and Comparison of Efficacy of Dopamine Agonists and Somatostatin Analogues

Abstract: The effects of DA are irrespective of baseline prolactin concentrations. Prior radiotherapy is associated with differences in GH and IGF-I response to DA and SSA therapy.

Cited by 67 publications

References 55 publications

The characteristics of acromegalic patients with hyperprolactinemia and the differences in patients with merely GH-secreting adenomas: clinical analysis of 279 cases

The characteristics of acromegalic patients with hyperprolactinemia and the differences in patients with merely GH-secreting adenomas: clinical analysis of 279 cases

Could different treatment approaches in acromegaly influence life expectancy? A comparative study between Bulgaria and Campania (Italy)

Cabergoline treatment in acromegaly: cons

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