Acromegaly, growth hormone

Prolonged exposure to elevated growth hormone and insulin-like growth factor I levels can lead to serious complications in patients with acromegaly. Aggressively manage... 

Biochemical assessment and long-term monitoring in patients with acromegaly Statement from a joint consensus conference of the Growth Hormone Research Society and the Pituitary Society. I Clin Endocrinol Metab 2004 89(7) 3099—3102. 

Acromegaly A pathologic condition characterized by excessive production of growth hormone during adulthood after epiphyseal (long bone) fusions have completed. 

The dopamine D2 agonists bromocriptine and cabergoline (pp. 114, 188) inhibit prolactin-releasing AH cells (indications suppression of lactation, prolactin-producing tumors). Excessive, but not normal, growth hormone release can also be inhibited (indication acromegaly) (3). 

Pegvisomant is a growth hormone receptor antagonist registered for the treatment of patients with acromegaly who had insufficient benefit from surgery or radiation. 

Acromegaly is almost always caused by a pimitary growth hormone (GH)-secreting adenoma, and transsphenoidal surgery is normally considered to be the first treatment of choice. A number of patients are not cured by surgery, however, and GH hypersecretion is nowadays treated actively, because of its known associated excess mortality. 

Mechanism of Action A dopamine agonist that directly stimulates dopamine receptors in the corpus striatum and inhibits prolactin secretion. Also suppresses secretion of growth hormone. Therapeutic Effect Improves symptoms of parkinsonism, suppresses galactorrhea, and reduces serum growth hormone concentrations in acromegaly. 

It is a peptide containing 14 amino acids and inhibits the release of growth hormone, TSH and prolactin from the pituitary and insulin and glucagon in pancreas. It has a very short plasma half-life. Because of its shorter duration of action and lack of specificity in inhibiting only GH secretion, its use in the treatment of acromegaly is limited. 

Indications Reduction of blood levels of growth hormone and IGF-I in acromegaly patients symptomatic treatment of me-... 

B. Indications and use Sandostatin is indicated to reduce blood levels of growth hormone and IGF-I (somatomedin-C) in acromegaly patients who have had inadequate response to or cannot be treated with surgical resection, pituitary irradiation, or bromocriptine mesylate at maximally tolerated doses. It is also indicated for the symptomatic treatment of patients with metastatic carcinoid tumors, where it suppresses or inhibits the severe diarrhea and flushing episodes associated with the disease, and for the treatment of the profuse watery diarrhea associated with VIP (vasoactive intestinal peptide)-secreting tumors (vipomas). 

Treatment of carcinoid and vasoactive intestinal peptide acromegaly (reduce blood levels of growth hormone), symptomatic treatment of metastatic carcinoid tumors, and profuse water diarrhea associated with intestinal tumors... 

The incidence of malignancy is increased in acromegaly, in which growth hormone is present in excess. Patients treated with growth hormone have therefore been carefully monitored. The cancer risk of growth hormone has been reviewed (93). 

Rowles S, Paisley A, Trainer PJ. Somastatin analogue versus growth-hormone antagonist treatment for acromegaly who should get what Curr Opin Endocrinol Diabetes 2003 10 265-71. 

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