China
Africa
Explore chapters and articles related to this topic
Management of Pituitary Disease
Published in R James A England, Eamon Shamil, Rajeev Mathew, Manohar Bance, Pavol Surda, Jemy Jose, Omar Hilmi, Adam J Donne, Scott-Brown's Essential Otorhinolaryngology, 2022
Somatotropinoma has a 50% chance of achieving biochemical remission from surgery. One third of patients have persistent disease. Persistent disease is associated with an approximately fourfold increased risk of colorectal carcinoma and with widespread arthralgia and arthritis, impaired glucose tolerance, hypertension, carpal tunnel syndrome, sweating, obstructive sleep apnea, and dysmorphophobia, all of which contribute to a 30% increase in all-cause mortality First-line adjuvant treatments are somatostatin analogs, which can normalise circulating growth hormone (GH) levels within 5 years. GH antagonist (pegvisomant) can reduce GH levels by 75%, and dopamine agonists (cabergoline) may be successful in a third of acromegaly patients.Conventional fractionated and stereotactic radiosurgery can be considered.
Acromegaly
Published in Nadia Barghouthi, Jessica Perini, Endocrine Diseases in Pregnancy and the Postpartum Period, 2021
Pegvisomant antagonizes GH binding to its receptors and inhibits peripheral production of IGF-1. In contrast to SRLs or dopamine agonists, GH hypersecretion persists with pegvisomant therapy. Therefore, GH levels should not be monitored to evaluate for effectiveness of pegvisomant.9 Unlike pasireotide, pegvisomant may provide the benefit of glycemic control by suppressing hepatic glucose production.13 Liver function tests should be regularly monitored for patients receiving pegvisomant, with one study demonstrating that 5.2% of patients develop transaminase levels three times greater than normal.15,16
Endocrine and Neuroendocrine Tumors
Published in Pat Price, Karol Sikora, Treatment of Cancer, 2020
Natasha Shrikrishnapalasuriyar, P.N. Plowman, Márta Korbonits, Ashley B. Grossman
Pegvisomant, a GH receptor antagonist, is used in patients who have persistently elevated IGF-1 levels despite maximal medical therapy or who are unable to take pasireotide. It is almost always effective when given at a sufficient dose, and is administered via a daily, weekly, or twice-weekly subcutaneous injection.35
New and emerging pharmacological treatment options for acromegaly
Published in Expert Opinion on Pharmacotherapy, 2021
Ximene Antunes, Leandro Kasuki, Mônica R. Gadelha
Currently, the pharmacological treatment of choice in persistent disease after surgery is fg-SRL (octreotide LAR and lanreotide autogel) in most cases, whereas monotherapy with dopamine agonist (cabergoline) may be an option in patients with mild disease [IGF-I levels up to 2.5x the upper limit of normal (ULN)] [6]. Although fg-SRL is the first option, it allows disease control in only approximately 30–40% of patients; nevertheless, reductions in GH and IGF-I levels and tumor mass are observed in the majority of cases [9,10]. When there is a response to fg-SRL but no disease control, combination therapy may be tried, with cabergoline being indicated for patients with mild disease (IGF-I up to 2.5 xULN). Disease control is achieved in approximately 30% of these cases [6,11]. For patients presenting a tumor response but still having elevated levels of IGF-I (higher than 2.5 xULN) after fg-SRL, combination therapy with the GH receptor antagonist pegvisomant is an option, with disease control being achieved in more than 70% of patients [12,13]. Pegvisomant can also be used as monotherapy when there is no tumor concern, allowing disease control in 73% of patients [12].
Emerging drugs for the treatment of acromegaly
Published in Expert Opinion on Emerging Drugs, 2020
Claudia Campana, Giuliana Corica, Federica Nista, Francesco Cocchiara, Giulia Graziani, Keyvan Khorrami, Marta Franco, Mara Boschetti, Diego Ferone, Federico Gatto
The knowledge of molecular mechanisms involved in GH hyper-secretion and tumor growth is the premise of new drug development. As mentioned above, somatotroph tumors express SSTs (mainly SST2 and SST5) and D2R. Based on the clinical efficacy of the combined therapy (SRLs plus DAs), and the functional interactions between SSTs and D2R observed on tumor cell membrane, chimeric molecules that can bind both SSTs and D2R have been developed [42,43]. Moreover, since SSTs still represent a major target in GH-secreting tumors, a small non-peptide molecule with high affinity for SST2 is currently under investigation [44]. Via its peculiar molecular structure this compound could activate the intracellular pathways in a different way compared to conventional SRLs, resulting in less receptor internalization and, therefore, improving response rate [44]. Another growing field in drug development for acromegaly regards the antisense molecules and two different formulations, both targeting GH receptor (GHR), are currently tested on Phase II clinical studies [45–47]. As for pegvisomant, the main action of these drugs is to control hormonal imbalance decreasing IGF-1 secretion by the liver.
Characteristics and outcome of surgically treated acromegaly patients attending an endocrinology clinic at a tertiary referral centre in Durban, South Africa over a period of 10 years
Published in Journal of Endocrinology, Metabolism and Diabetes of South Africa, 2018
Abdurraouf Masaud Elbueishi, Fraser J Pirie, Ayesha A Motala
The majority of patients (88.5%) in the current study required adjunctive medical therapy in order to achieve disease control. Although pegvisomant is not available to state patients in KwaZulu-Natal, both octreotide and dopamine agonists are available and were used as treatment in the current study. Adjunctive medical therapy is reported to be required in 83.9% of patients in other studies and conventional radiotherapy has been used in up to 60% of subjects in other centres.18 In the Cape Town study adjuvant therapy was confined to radiotherapy as dopamine agonists and somatostatin analogues were not available for use at that time.11