Acromegaly Medication
- Author: Hasnain M Khandwala, MD, FRCPC; Chief Editor: George T Griffing, MD more...
Medication Summary
After transsphenoidal surgery, somatostatin analogues are generally the first line of treatment, followed by GH receptor antagonist or dopamine agonists.
Somatostatin analogues
Class Summary
Used to reduce blood levels of GH and IGF-I in patients who have an inadequate response to surgery. Their role as the primary treatment modality is being evaluated.
Octreotide (Sandostatin)
Acts primarily on somatostatin receptor subtypes II and V. Inhibits GH secretion and has a multitude of other endocrine and nonendocrine effects, including inhibition of glucagon, VIP, and GI peptides. Periodically monitor GH/IGF-I concentrations to assess response.
Octreotide LAR (Sandostatin LAR)
Long-acting somatostatin analogue is administered every 4 wk. Similar improvements occur in GH/IGF-I concentration compared to octreotide but are associated with fewer adverse effects. A trial of short-acting somatostatin analogue is necessary to confirm the patient's ability to tolerate the compound.
Lanreotide (Somatuline Depot)
Indicated for long-term treatment of acromegaly in patients who experience inadequate response to other therapies. Octapeptide analogue of natural somatostatin. Inhibits a variety of endocrine, neuroendocrine, exocrine, and paracrine functions. Elicits high affinity for human somatostatin receptors 2, 3, and 5. Inhibits basal secretion of motilin, gastric inhibitory peptide, and pancreatic polypeptide. Markedly inhibits meal-induced increases in superior mesenteric artery blood flow and portal venous blood flow. Also significantly decreases prostaglandin E1 – stimulated jejunal secretion of water, sodium, potassium, and chloride. Reduces prolactin levels in acromegalic patients when treated long term.
Dopamine agonists
Class Summary
Usually added to somatostatin analogues if complete remission has not been achieved. Have modest effects if used as a single agent.
Bromocriptine (Parlodel)
Acts on central dopamine receptors. More effective in tumors that co-secrete prolactin. Dose used to treat acromegaly is usually much higher than that used for hyperprolactinemia.
Growth hormone antagonists
Class Summary
Blocks GH binding to receptors, resulting in decreased IGF-1, IGFBP-3, and acid-labile subunit.
Pegvisomant (Somavert)
Recombinant DNA analog of human growth hormone (GH) that is structurally altered to act as a GH receptor antagonist. Selectively binds to growth hormone (GH) receptors on cell surfaces, thereby blocking endogenous GH binding. This action interferes with GH signal transduction, resulting in decreased insulinlike growth factor-I (IGF-I), IGF binding protein-3 (IGFBP-3), and acid-labile subunit (ALS).
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