Medical therapy of acromegaly

Abstract

In acromegaly, selective adenomectomy of the GH-producing pituitary tumour remains the treatment of choice, followed by external irradiation if plasma GH levels are not normalized and paradoxical responses of GH to bromocriptine, TRH and/or LHRH have not disappeared. In older patients with a relatively inactive clinical picture and in whom general anaesthesia might be contra-indicated, radiotherapy can be administered as a primary form of treatment. The dopamine agonist bromocriptine is an effective drug in most patients during the period before the full effects of radiotherapy are reached. Bromocriptine therapy can be considered a primary form of treatment for a limited period of time in young patients who want to have children, particularly when concomitant hyperprolactinaemia is present, and in patients who refuse other forms of treatment. Only in a few hyperprolactinaemic acromegalic patients has radiographic evidence of tumour shrinkage been reported during chronic bromocriptine treatment. Presumably these were tumours containing both GH- and prolactin-producing cells.