Treatment strategy for acromegaly

Abstract

The first - line of treatment for acromegaly is surgery. Therefore improving of surgical intervention is very important for the treatment outcome of acromegaly. However, it is difficult to treat growth hormone (GH)producing pituitary adenomas with cavernous invasion by surgery alone; additional medical treatment is needed for the complementary treatment of these cases. Additionally, transsphenoidal surgery is a basic method for treating acromegaly. Endoscopic surgery has also been widely used, either as pure endoscopic surgery or microscopic surgery - assisted endoscopy. The overall surgical outcome success rate for acromegaly is 70％, and further medical treatment is prescribed for patients with incomplete surgical outcomes. Somatostatin analogs (octreotide and lanreotide) are the first - line medications for acromegaly, and the normalization rate of insulin - like growth factor - I (IGF - I)is about 50 - 70％. Dopamine agonist or GH receptor antagonist are also used for treating acromegaly. Although economically more viable than somatostatin analogs and GH receptor antagonists, oral dopamine agonists have a lower efficacy. GH receptor antagonist has a high efficacy; however, it has many side effects. Stereotactic irradiation is also a useful treatment choice for acromegaly. The normalization rate of IGF - I after stereotactic irradiation is about 60 - 70％, although it requires several years for proper normalization. The surgical and medical therapy options for acromegaly are the focused of this review.