New cross-roads for second line medical therapy in acromegaly

Abstract

Acromegaly is a complex disorder caused by growth hormone excess mostly due to a pituitary adenoma. Surgery represents the first option but rate of long time success is almost 50% thus the patients need other therapies. Apart from radiation, medical therapy panel includes previously used long-acting formulas of first-generation somatostatin analogues like ocreotide or lanreotide and, moreover, pasireotide LAR which is a recently introduced second-generation analogue. Non responders to prior medication, proved a good response to this as pointed by C2305 extension trial or PAOLA study. The rate of overresponse to pasireotide may be explained by a different receptor target: mostly on somatostatin receptor type 5 opposite to type 2 as it acts first-generation compounds. The tolerance of pasireotide LAR is good; the safety profile includes the awareness of hyperglycaemia risk. The cross-road that follows the lack of acromegaly control after a patient was treated with somatostatin analogue of first generation is currently more complex since pasireotide LAR became a feasible option.

Keywords

• acromegaly
• pasireotide LAR
• pituitary gland
• tumour
• glycaemia