TY - JOUR
T1 - Management of endocrine disease: GH excess: diagnosis and medical therapy
T2 - Diagnosis and medical therapy
AU - Andersen, Marianne
PY - 2014/1
Y1 - 2014/1
N2 - Acromegaly is predominantly caused by a pituitary adenoma, which secretes an excess of GH resulting in increased IGF1 levels. Most of the GH assays used currently measure only the levels of the 22 kDa form of GH. In theory, the diagnostic sensitivity may be lower compared with the previous assays, which have used polyclonal antibodies. Many GH-secreting adenomas are plurihormonal and may co-secrete prolactin, TSH and α-subunit. Hyperprolactinaemia is found in 30-40% of patients with acromegaly, and hyperprolactinaemia may occasionally be diagnosed before acromegaly is apparent. Although trans-sphenoidal surgery of a GH-secreting adenoma remains the first treatment at most centres, the role of somatostatin analogues, octreotide long-acting repeatable and lanreotide Autogel as primary therapy is still the subject of some debate. Although the normalisation of GH and IGF1 levels is the main objective in all patients with acromegaly, GH and IGF1 levels may be discordant, especially during somatostatin analogue therapy. This discordance usually takes the form of high GH levels and an IGF1 level towards the upper limit of the normal range. Pasireotide, a new somatostatin analogue, may be more efficacious in some patients, but the drug has not yet been registered for acromegaly. Papers published on pasireotide have reported an increased risk of diabetes mellitus due to a reduction in insulin levels. Pegvisomant, the GH receptor antagonist, is indicated - alone or in combination with a somatostatin analogue - in most patients who fail to enter remission on a somatostatin analogue. Dopamine-D2-agonists may be effective as monotherapy in a few patients, but it may prove necessary to apply combination therapy involving a somatostatin analogue and/or pegvisomant.
AB - Acromegaly is predominantly caused by a pituitary adenoma, which secretes an excess of GH resulting in increased IGF1 levels. Most of the GH assays used currently measure only the levels of the 22 kDa form of GH. In theory, the diagnostic sensitivity may be lower compared with the previous assays, which have used polyclonal antibodies. Many GH-secreting adenomas are plurihormonal and may co-secrete prolactin, TSH and α-subunit. Hyperprolactinaemia is found in 30-40% of patients with acromegaly, and hyperprolactinaemia may occasionally be diagnosed before acromegaly is apparent. Although trans-sphenoidal surgery of a GH-secreting adenoma remains the first treatment at most centres, the role of somatostatin analogues, octreotide long-acting repeatable and lanreotide Autogel as primary therapy is still the subject of some debate. Although the normalisation of GH and IGF1 levels is the main objective in all patients with acromegaly, GH and IGF1 levels may be discordant, especially during somatostatin analogue therapy. This discordance usually takes the form of high GH levels and an IGF1 level towards the upper limit of the normal range. Pasireotide, a new somatostatin analogue, may be more efficacious in some patients, but the drug has not yet been registered for acromegaly. Papers published on pasireotide have reported an increased risk of diabetes mellitus due to a reduction in insulin levels. Pegvisomant, the GH receptor antagonist, is indicated - alone or in combination with a somatostatin analogue - in most patients who fail to enter remission on a somatostatin analogue. Dopamine-D2-agonists may be effective as monotherapy in a few patients, but it may prove necessary to apply combination therapy involving a somatostatin analogue and/or pegvisomant.
KW - Acromegaly/blood/diagnosis/drug therapy/etiology Antineoplastic Agents/therapeutic use Chemotherapy, Adjuvant Dopamine Agonists/therapeutic use Drug Therapy, Combination Growth Hormone-Secreting Pituitary Adenoma/drug therapy/genetics/physiopathology/surg
KW - Hyperprolactinemia/etiology
KW - Acromegaly/blood
KW - Humans
KW - Antineoplastic Agents/therapeutic use
KW - Dopamine Agonists/therapeutic use
KW - Intracellular Signaling Peptides and Proteins/genetics
KW - Growth Hormone-Secreting Pituitary Adenoma/drug therapy
KW - Chemotherapy, Adjuvant
KW - Mutation
KW - Drug Therapy, Combination
KW - Insulin-Like Growth Factor I/analysis
KW - Somatostatin/analogs & derivatives
KW - Human Growth Hormone/analogs & derivatives
U2 - 10.1530/EJE-13-0532
DO - 10.1530/EJE-13-0532
M3 - Journal article
C2 - 24144967
SN - 0804-4643
VL - 170
SP - R31-R41
JO - European Journal of Endocrinology
JF - European Journal of Endocrinology
IS - 1
ER -