Acromegaly: management

Trans-sphenoidal surgery is first-line treatment for acromegaly in the majority of patients

Dopamine agonists

• for example bromocriptine
• the first effective medical treatment for acromegaly, however now superseded by somatostatin analogues
• effective only in a minority of patients

Somatostatin analogue

• for example octreotide
• effective in 50-70% of patients
• may be used as an adjunct to surgery

Pegvisomant

• GH receptor antagonist - prevents dimerization of the GH receptor
• once daily s/c administration
• very effective - decreases IGF-1 levels in 90% of patients to normal
• doesn't reduce tumour volume therefore surgery still needed if mass effect

External irradiation is sometimes used for older patients or following failed surgical/medical treatment