Personalized Medical Treatment of Patients With Acromegaly: A Review

Dawn Shao Ting Lim, Maria Fleseriu

Research output: Contribution to journalReview articlepeer-review

Abstract

Acromegaly is associated with significant morbidity and mortality if it is not appropriately treated. In addition to insulin-like growth factor 1 and growth hormone normalization as well as tumor shrinkage, the treatment goals include relieving symptoms, managing complications, and improving patients’ quality of life. Surgical resection is a first-line treatment option for most patients, with few being pretreated preoperatively with medications. Somatostatin receptor ligands (SRLs), injectable and, more recently, oral capsules, have been the cornerstone of first-line medical therapy for persistent disease. However, several factors, including sparsely granulated adenomas, absent or low somatostatin receptor status, T2-hyperintensity imaging, young age, and aryl hydrocarbon receptor-interacting protein mutations, can predict first-generation SRL resistance. Patients with these characteristics may be better candidates for the growth hormone receptor antagonist pegvisomant, or in cases of large tumors, the second-generation SRL pasireotide. Combination therapy should be further pursued in patients who remain biochemically uncontrolled or have a high remnant tumor after monotherapy. An efficacious and cost-effective pegvisomant dose-sparing effect of SRLs when used in combination has been demonstrated. With such a wide array of medical treatment options, it is becoming increasingly important to tailor treatment to patients’ unique characteristics and preferences, with a goal of personalizing management to achieve high-quality outcomes.

Original languageEnglish (US)
Pages (from-to)321-332
Number of pages12
JournalEndocrine Practice
Volume28
Issue number3
DOIs
StatePublished - Mar 2022
Externally publishedYes

Keywords

  • SRLs
  • acromegaly
  • individualized treatment
  • pasireotide
  • pegvisomant

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Endocrinology

Fingerprint

Dive into the research topics of 'Personalized Medical Treatment of Patients With Acromegaly: A Review'. Together they form a unique fingerprint.

Cite this