Treatment of acromegaly: future

Recent progress in the therapy of GH-secreting pituitary tumors includes three treatment modalities: surgery, radiotherapy, and medications. A combination of treatment options is often required to attain therapeutic goals, increasing the potential for a combination of unwanted side effects. The focus of this review is to discuss medical therapy of GH-secreting adenomas focusing on newer drug compounds. In selected cases, therapeutic goals are attained with somatostatin analog treatment alone. The GH receptor antagonist controls IGF-I hypersecretion, and its use in combination with somatostatin analogs in selected patients is tempting but requires further evaluation. Somatostatin multireceptor ligand SOM230 and a somatostatin-dopamine chimeric ligand are new compounds that may improve therapy outcome. Careful individualization of therapy is important in deciding the ideal treatment approach, and primary medical therapy may be recommended in selected patients.