Медицинский совет (Jan 2020)
Modern methods of medical treatment of acromegaly
Abstract
The continuing difficulty of treatment of acromegaly depends on: late diagnosis of the disease, the multiplicity of pathological variants of GH-secreting adenomas, the presence of complicated forms of the disease, and the lack of differentiated approach when choosing a treatment strategy. At the present time, when there are many divergent therapeutic tools to achieve the target values depending on the specific structure of the pathological tumor tissue, the main problem lies in the establishment of adequate algorithms to ensure prompt achievement and maintenance of biochemical remission. Due to the improvement of surgical aids medical therapy for acromegaly is generally used as a second line treatment, assignable at continuing disease activity after non-radical adenomectomy.). With the introduction of prolongated analogs of somatostatin, mostly affecting the 2nd (octreotide, lanreotide), or 5th (pasireotide) subtypes of the somatostatin receptors, selective dopamine agonists (cabergoline), and growth hormone receptor antagonist (pegvisomant) into wide clinical practice patients received a great opportunity to achieve a stable biochemical control of acromegaly regardless of secretory activity and receptor phenotype of the tumor tissue. The present paper reveals the mechanisms of action and the characteristics of the most common pharmacological agents, as well as the indications for their use in the combined treatment of acromegaly. It discusses the topic of therapeutic benefit with resistance to somatostatin analogues of the 1st generation. The results of a multicenter randomized clinical trials on the effectiveness and safety of somatostatin analogs, as well as current international recommendations of optimal schemes of therapeutic benefit in acromegaly are also presented here. It stressed the need for a differentiated approach to the treatment based on the clinical and pathological features of somatotropinoms and the individual sensitivity of patients to drugs used.
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