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Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas
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Hypothesis: Extra-hepatic acromegaly: a new paradigm?

Sebastian J Neggers1, John J Kopchick, Jens O L Jørgensen

  • 1Department of Internal Medicine, Erasmus University MC, PO Box 2040, 3000 CA Rotterdam, The Netherlands.

European Journal of Endocrinology
|November 4, 2010
PubMed
Summary

Long-acting somatostatin analogs and pegvisomant treat acromegaly but impact the GH-IGF1 axis differently. New monitoring strategies are needed to assess disease activity effectively.

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Area of Science:

  • Endocrinology
  • Pharmacology

Background:

  • Acromegaly treatment with long-acting somatostatin analogs (LA-SMSA) and pegvisomant (PEGV) aims to normalize IGF1.
  • These therapies affect the GH-IGF1 axis distinctly, complicating traditional monitoring.
  • LA-SMSA may normalize IGF1 while GH action persists in extra-hepatic tissues, termed 'extra-hepatic acromegaly'.

Purpose of the Study:

  • To challenge current concepts in acromegaly treatment and monitoring.
  • To highlight the differential impact of LA-SMSA and PEGV on the GH-IGF1 axis.
  • To propose the concept of 'extra-hepatic acromegaly' due to incomplete disease control with LA-SMSA.

Main Methods:

  • Review of the distinct mechanisms of action of LA-SMSA and PEGV.
  • Analysis of biochemical monitoring challenges in acromegaly patients.
  • Postulation of new clinical scenarios based on drug action.

Main Results:

  • LA-SMSA can normalize serum IGF1 while GH action persists in extra-hepatic tissues.
  • PEGV blocks GH action but may elevate serum GH, decoupling it from IGF1.
  • Traditional biomarkers may not reliably reflect disease activity under these treatments.

Conclusions:

  • Current acromegaly monitoring strategies are insufficient for LA-SMSA and PEGV therapies.
  • The concept of 'extra-hepatic acromegaly' requires further investigation.
  • Combination therapy with LA-SMSA and PEGV warrants consideration due to their different mechanisms.