Diagnosis and treatment of acromegaly

Peter J Trainer

Christie Hospital, Manchester

Summer School 15-18 July 2003
University of Manchester, Hulme Hall, Manchester, UK

Acromegaly is a disfiguring and disabling illness which, when inadequately treated, reduces life expectancy by a decade, on average. Large strides have been made in the treatment of acromegaly such that we are now entering on an era when it should be possible to achieve biochemical disease control in all, or at least virtually all, patients with acromegaly. The prospect of curative surgery has improved with advances in surgical technique, and the greater awareness of the need for transsphenoidal surgery to be performed by specialist pituitary surgeons, while refinements in radiotherapy make it a safe and effective option for patients not cured by the surgeon. The majority of patients with acromegaly require medical treatment at some point and this field has been one of the fastest developing areas of clinical endocrinology. The newer, better-tolerated and more potent dopamine agonists, such as cabergoline, plus the availability of the long-acting somatostatin analogues octreotide and lanreotide, allow biochemical disease control to be achieved in the majority of patients. The prospects of new somatostatin analogues, together with the imminent availability of the GH receptor antagonist pegvisomant, means that the challenge in the future will be optimising therapeutic algorithms to ensure that individual patients achieve disease control while controlling tumour volume, preserving pituitary function and relieving symptoms. An implication of the ability to offer effective treatment is the increased onus on physicians of all sorts to ensure acromegaly is diagnosed and treated as early as possible.

The opinions expressed in this paper are those of the speaker and do not necessarily reflect the views of the Society

Revised: 04-Sep-2003