Shlomo Melmed,
Ivor Jackson,
David Kleinberg and
Anne Klibanski
Cedars-Sinai Research Institute, University of California School of
Medicine (S.M.), Los Angeles, California 90048; Rhode Island
Hospital/Brown University School of Medicine (I.J.), Providence, Rhode
Island 02903; New York University Medical Center (D.K.), New York, New
York 10016; and Neuroendocrine Clinical Center, Massachusetts General
Hospital, Harvard Medical School (A.K.), Boston, Massachusetts
02114
Address all correspondence and requests for reprints to: Dr. Shlomo Melmed, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Room B-131, Los Angeles, California 90048-1865.
Acromegaly, an indolent disorder of growth hormone (GH) hypersecretion
ismost typically caused by a somatotroph cell adenoma and maybe
treated by several modalities. Transsphenoidal surgical resectionof
micro-adenomas by experienced neurosurgeons results in biochemical
normalization(postglucose GH <2 ng/mL, assay-dependent, age- and
sex-matchedIGF-I levels) in 70% of patients. However, over 65% of
GH-secretingadenomas are invasive or macroadenomas, and over 50% of
thesepatients have persistent postoperative GH hypersecretion.
Irradiationof adenomas results in attenuation of GH secretion to more
than5 ng/mL in 50% of subjects after 12 yr. However, the percentof
parents who normalize IGF-I levels is less certain. Mostof these
patients develop associated pituitary failure and rarelydevelop other
local adverse effects. About 60% of patients receivingsomatostatin
analogs achieve normalized IGF-I levels. Efficacyof medical management
with somatostatin analogs may be improvedby increasing injection
frequency, changing delivery modes todepot preparations, and in the
future, development of novelSRIF receptor subtype-specific analogs. An
integrated approachto acromegaly management based upon relative risks
and benefitsof the currently available therapeutic modes is presented
thatallows for a national individualized strategy designed to achieve
maximalbiochemical control of GH hypersecretion and elevated IGF-I
levels.
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