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Clinical importance of achieving biochemical control with medical therapy in adult patients with acromegaly

Authors Christofides EA

Received 11 December 2015

Accepted for publication 24 March 2016

Published 13 July 2016 Volume 2016:10 Pages 1217—1225

DOI https://doi.org/10.2147/PPA.S102302

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Doris Leung

Peer reviewer comments 2

Editor who approved publication: Dr Johnny Chen

Elena A Christofides

Endocrinology Associates, Inc., Columbus, OH, USA

Abstract: In acromegaly, achieving biochemical control (growth hormone [GH] level <1.0 ng/mL and age- and sex-normalized levels of insulin-like growth factor 1 [IGF-1]) through timely diagnosis and appropriate treatment provides an opportunity to improve patient outcomes. Diagnosis of acromegaly is challenging because it is rooted in observing subtle clinical manifestations, and it is typical for acromegaly to evolve for up to 10 years before it is recognized. This results in chronic exposure to elevated levels of GH and IGF-1 and delay in patients receiving appropriate treatment, which consequently increases mortality risk. In this review, the clinical impact of elevated GH and IGF-1 levels, the effectiveness of current therapies, and the potential role of novel treatments for acromegaly will be discussed. Clinical burden of acromegaly and benefits associated with management of GH and IGF-1 levels will be reviewed. Major treatment paradigms in acromegaly include surgery, medical therapy, and radiotherapy. With medical therapies, such as somatostatin analogs, dopamine agonists, and GH receptor antagonists, a substantial proportion of patients achieve reduced GH and normalized IGF-1 levels. In addition, signs and symptoms, quality of life, and comorbidities have also been reported to improve to varying degrees in patients who achieve biochemical control. Currently, there are several innovative therapies in development to improve patient outcomes, patient use, and access. Timely biochemical control of acromegaly ensures that the patient can ultimately improve morbidity and mortality from this disease and its extensive consequences.

Keywords: disease burden, growth hormone, insulin-like growth factor 1, medical therapy, pituitary

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