Updates in Diagnosis and Treatment of Acromegaly
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Acromegaly is a chronic disorder characterised by growth hormone (GH) hypersecretion, predominantly caused by a pituitary adenoma. Disease prevalence ranges from 2.8–13.7 cases and annual incidence is between 0.2–1.1 cases/100,000 people; however, real incidence is likely much higher. Average age at diagnosis ranges from 40–50 years and mean delay in diagnosis is approximately 10–11 years. More than 95% of acromegalic cases are secondary to a pituitary adenoma: somatotrophs or GH-producing cells. In <5% of cases, acromegaly is related to a hypothalamic or neuroendocrine tumours, which secrete GH-releasing hormone, leading to excess GH. Peripheral GH-secreting tumours are exceedingly rare.

GH stimulates synthesis of insulin-like growth factor 1 (IGF-1) from the liver and systemic tissues. Hypersecretion of GH leads to excess production of IGF-1. IGF-1 mediates most of the phenotypic features and metabolic effects of GH, but GH excess also has direct detrimental effects. Acromegaly is associated with increased morbidity and mortality, but mortality returns to that of the normal population after appropriate treatment and biochemical normalisation.

Novel insights into the diagnosis and pathophysiology of acromegaly have been acquired over recent years. Increased awareness of assay technical issues and discordant results affecting the biochemical assessment of the disease will ensure prompt diagnosis and initiation of treatment. Expanded knowledge on the histological and molecular levels, and development of new markers of response and resistance to SRL emphasised the importance of a personalised approach rather than following a universal algorithm for therapy. Future studies are needed to clarify the role of innovative formulation, combination and peri-operative pharmacotherapy on disease remission rate and patient QoL. The treatment of acromegaly remains multimodal for most patients and a multidisciplinary team is essential for optimal disease management and outcome.

Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6182922/