TY - JOUR
T1 - Approach to the Patient With Treatment-resistant Acromegaly
AU - Coopmans, Eva C.
AU - Van Der Lely, Aart J.
AU - Neggers, Sebastian J.C.M.M.
N1 - © The Author(s) 2022. Published by Oxford University Press on behalf of the Endocrine Society. All rights reserved. For permissions, please e-mail: [email protected].
PY - 2022/5/17
Y1 - 2022/5/17
N2 - Although most tumors in patients with acromegaly are benign and are cured or controlled by surgery and/or first-generation somatostatin receptor ligands therapy, some can behave more aggressively and are resistant to these standard therapies. Acromegaly, if left untreated, is a rare and chronic disorder, commonly caused by a GH-producing pituitary adenoma and is associated with significant comorbidities and an increased mortality. Transsphenoidal surgery is considered the mainstay of acromegaly management, but medical therapy has an increasingly important role. However, disease activity is not fully controlled in a significant number of patients treated with surgery and/or high-dose first-generation somatostatin receptor ligand monotherapy. In these circumstances, therefore, repeated surgery, second-line medical therapy, and radiotherapy, alone or combined as multimodal therapeutic strategies should be considered, in a patient-centered perspective.
AB - Although most tumors in patients with acromegaly are benign and are cured or controlled by surgery and/or first-generation somatostatin receptor ligands therapy, some can behave more aggressively and are resistant to these standard therapies. Acromegaly, if left untreated, is a rare and chronic disorder, commonly caused by a GH-producing pituitary adenoma and is associated with significant comorbidities and an increased mortality. Transsphenoidal surgery is considered the mainstay of acromegaly management, but medical therapy has an increasingly important role. However, disease activity is not fully controlled in a significant number of patients treated with surgery and/or high-dose first-generation somatostatin receptor ligand monotherapy. In these circumstances, therefore, repeated surgery, second-line medical therapy, and radiotherapy, alone or combined as multimodal therapeutic strategies should be considered, in a patient-centered perspective.
KW - acromegaly
KW - clinical case
KW - medical treatment
KW - pasireotide
KW - pegvisomant
KW - pituitary
KW - somatostatin analogs
KW - surgery and radiotherapy
KW - Humans
KW - Pituitary Neoplasms/complications
KW - Acromegaly/drug therapy
KW - Human Growth Hormone/therapeutic use
KW - Receptors, Somatostatin
KW - Somatostatin
UR - http://www.scopus.com/inward/record.url?scp=85130644125&partnerID=8YFLogxK
U2 - 10.1210/clinem/dgac037
DO - 10.1210/clinem/dgac037
M3 - Article
C2 - 35090028
AN - SCOPUS:85130644125
SN - 0021-972X
VL - 107
SP - 1759
EP - 1766
JO - Journal of Clinical Endocrinology and Metabolism
JF - Journal of Clinical Endocrinology and Metabolism
IS - 6
ER -