Acromegaly treatment

Treatment of Parkinson s disease, acromegaly. Treatment of neuroleptic malignant syndrome, cocaine addiction, hyperprolactemia associated with pituitary adenomas. 

Acromegaly Treatment Consensus Workshop Participants. Consensus guideUnes for acromegaly management. J CUn Endocrinol Metab 2002 87 4054-4058. 

Somatostatin analogs are the mainstay of pharmacotherapy for the treatment of acromegaly when surgery and radiation are contraindicated or have failed. 

Adapted from AACE Medical Guidelines for Clinical Practice for the diagnosis and treatment of acromegaly. Endocr Pract. 2004 1 0(3) 21 3-225, by permission of publisher, AACE Corp. 

Identify any significant comorbidities associated with acromegaly that require immediate treatment or early diagnosis. 

Giustina A, Casanueva FF, Cavagnini F, et al. Diagnosis and treatment of acromegaly complications. ] Endocrinol Invest 2003 26(12) 1242-1247. 

Somavert (hGH analogue, i.e. antagonist) Pharmacia Treatment of selected patients suffering from acromegaly... 

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. 

Dopamine agonists are also used for the treatment of acromegaly, but although they are much cheaper than somatostatin analogues, they are also less effective, and rarely normalize serum GH concentrations. 

Ayuk J, Stewart SE, Stewart PM, Sheppard MC. Longterm safety and efficacy of depot long-acting somatostatin analogs for the treatment of acromegaly. J Clin Endocrinol Metab 2002 87(9) 4142-6. 

Somatostatin has a very brief half-life in serum and is not useful clinically. An 8-amino acid analogue with 2 D-amino acids substituted for the naturally occurring L-amino acids is more stable, and monthly injections of a depot form of this analogue (octreotide, Sandostatin LAR) have several uses. Long-acting octreotide is used to treat acromegaly, as described earlier. It is also used to counteract unpleasant effects caused by overproduction of secreted bioactive substances produced by neuroendocrine tumors, including hyperinsulinemia from insulinomas and secretions from carcinoid tumors that cause severe diarrhea. Octreotide may also control severe diarrhea associated with AIDS that has not responded to other treatments. 

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. 

It is used in hyperprolactinemia and for suppression of lactation and breast engorgement. It is also useful in parkinsonism because it has levodopa like actions and in the treatment of acromegaly. Dose PROCTINAL 1.25 mg BD. 

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... 

A long-acting formulation of lanreotide, another octapeptide somatostatin analog, was approved by the FDA in 2007 for treatment of acromegaly. Lanreotide appears to have effects comparable to those of octreotide on reducing GH levels and normalizing IGF-1 concentrations. 

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