New directions in pharmacological treatment of acromegaly

Background/objectives: The aim of treatment for acromegaly is to control tumour growth, relieve symptoms and ensure biochemical cure. With specific, well-tolerated medication, long-time primary or preoperative treatment should be discussed. Methods: A PubMed search for literature ('somatostatin' and 'pituitary') was performed to explore different medical treatment options in today's clinics, which often use a combination of modalities. Clinical trial databases (ClinicalTrials.gov) were also searched for current clinical studies on acromegaly in order to reassess new directions in medical treatment. The cornerstone for medical treatment is somatostatin analogues (SAs). SAs control tumour growth and hormone hypersecretion in most patients. There seems, however, to be dissociation between the antisecretory and antiproliferative effects. New analogues with high affinity for other somatostatin receptor (SSTR) subtypes are being investigated. Chimeric compounds, which bind the SSTR as well as the dopamine receptor, are new potential alternatives. Patients not controlled on SAs (or dopamine agonists, or a combination) will be evaluated for treatment with the highly effective growth hormone receptor antagonist, as monotherapy or in combination with SAs. Results/conclusion: With the variety of medications we have today and those expected to come into clinical use in coming years, acromegaly can be controlled in almost all patients. There has already been a drift towards medical treatment also as a primary option, and it is to be expected that this will continue. Treatment should be tailored for the individual case, also taking into account long-term effects, convenience for the patient and costs for society.