Uj gyógyszeres terápiás lehetóségek az acromegalia kezelésére.

Translated title of the contribution: Novel pharmacologic therapies in acromegaly

M. Góth, Erika Hubina, László Kovács, I. Szabolcs

Research output: Contribution to journalArticle

Abstract

The primary aim of therapy should be to remove symptoms, reduce tumor bulk, prevent relapse, and improve long-term outcome. Surgery, radiotherapy and medical therapies are used to achieve these aims. Post-treatment mean "safe" serum growth hormone values of <2.5 ng/ml should be the therapeutic goal. Transsphenoidal surgery remains the first line treatment for acromegaly. Patients with microadenoma can expect 85%, while those with macroadenoma 50% chance to achieve safe serum growth hormone levels. Less than 20% of acromegalics respond to treatment with bromocriptine, while quinagolide and cabergoline may show better clinical response; the success rate is higher for tumors secreting both growth hormone and prolactin. Dopamine agonists may be considered either in combination with somatostatin-analogues or as monotherapy in selected patients, and in those with co-secretion of prolactin. Octreotide (Sandostatin, Novartis) is a synthetic somatostatin-analogue, which is administered subcutaneously in doses between 100 and 250 micrograms 3 times daily. Long-acting octreotide (Sandostatin LAR, Novartis) contains octreotide incorporated into microspheres of biodegradable polymer. To effectively lower serum growth hormone levels, monthly injections of 10-30 mg of long-acting octreotide are needed, serum growth hormone falls to 2.5 ng/ml in 70% of cases, and serum insulin-like growth factor I normalizes in 67%. Slow release lanreotide (Somatuline SR, Ipsen) is an alternative depot long-acting somatostatin-analogue, which is administered in a dose of 30 mg intramuscularly every 14, 10 or 7 days. Both compounds are equally, if not more, effective than subcutaneous octreotide, and significantly improve patient compliance. Pegvisomant (Sensus Drug Development Corporation) is a genetically engineered growth hormone receptor antagonist, which inhibits growth hormone action. When given subcutaneously in a dose of 20 mg/day, serum insulin-like growth factor I levels return to normal in 90% of patients. Theoretical concerns of tumor expansion have not been a problem to date, but long term studies are needed. Primary medical--somatostatin-analogue--therapy is recommended if surgery fails, if the patient refuses or unsuited for surgery and it may be also considered in patients with macroadenoma with extra--but not suprasellar extension, since the surgical "cure" rates of these tumors are low.

Original languageHungarian
Pages (from-to)1057-1062
Number of pages6
JournalOrvosi Hetilap
Volume143
Issue number19 Suppl
Publication statusPublished - May 12 2002

Fingerprint

Acromegaly
Octreotide
Growth Hormone
Somatostatin
Serum
Insulin-Like Growth Factor I
Prolactin
Therapeutics
Neoplasms
Somatotropin Receptors
Hormone Antagonists
Bromocriptine
Dopamine Agonists
Patient Compliance
Microspheres
Polymers
Radiotherapy
Recurrence
Injections
Pharmaceutical Preparations

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Uj gyógyszeres terápiás lehetóségek az acromegalia kezelésére. / Góth, M.; Hubina, Erika; Kovács, László; Szabolcs, I.

In: Orvosi Hetilap, Vol. 143, No. 19 Suppl, 12.05.2002, p. 1057-1062.

Research output: Contribution to journalArticle

Góth, M, Hubina, E, Kovács, L & Szabolcs, I 2002, 'Uj gyógyszeres terápiás lehetóségek az acromegalia kezelésére.', Orvosi Hetilap, vol. 143, no. 19 Suppl, pp. 1057-1062.
Góth, M. ; Hubina, Erika ; Kovács, László ; Szabolcs, I. / Uj gyógyszeres terápiás lehetóségek az acromegalia kezelésére. In: Orvosi Hetilap. 2002 ; Vol. 143, No. 19 Suppl. pp. 1057-1062.
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