Current therapy for acromegaly

Acromegaly is a disabling disease that is associated with reduced life expectancy. Lowering growth hormone (GH) concentrations rapidly improves patient wellbeing. Recent data also indicate that GH concentrations <2.5 mu g l(-1) are associated with improved mortality, providing a therapeutic goal in the majority of patients. In most cases, initial therapy should be surgical via the transsphenoidal route and conducted by an experienced operator. In such centres of excellence, similar to 60 out of every 100 acromegalic patients should be 'cured' (GH <2.5 mu g l(-1)) by surgery alone. Effective medical therapies have been introduced in the form of long-acting somatostatin analogues - octreotide and lanreotide - and depot preparations of these drugs result in lowering of GH to <2.5 mu g l(-1) and normalization of IGF-I concentrations in 55-65% of cases. Preliminary results are also emerging on Pegvisomant, a genetically engineered GH receptor antagonist, which is clinically and biochemically very effective. It is likely that this drug will be licensed for use in patients with acromegaly in the near future. These effective medical therapies will undoubtedly raise the issue of their use as primary therapy for acromegaly but at present they should be used as an adjunct to surgery and/or radiotherapy.