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Published on: January 17, 2018
Modern approach to resistant acromegaly
Andrea Giustina1, Luigi di Filippo2, Melin M Uygur2
1Institute of Endocrine and Metabolic Sciences (IEMS), Università Vita-Salute San Raffaele, IRCCS Ospedale San Raffaele, Milan, Italy. giustina.andrea@hsr.it.
Background:
Targets of acromegaly treatment are normalization of biochemical values, removal/reduction/stabilization of the pituitary mass, control of clinical activity and mortality with a multimodal/multidisciplinary approach. Despite significant technological and pharmacological progress, still several patients with acromegaly bear a resistant somatotroph adenoma and active disease may persist for many years with resultant poor clinical outcomes.
Aim:
To review briefly definition and pathophysiology of resistance to acromegaly treatment and the options of medical treatment in this context, exploring the role of novel clinical and molecular biomarkers in the personalization of therapy and proposing updates to the currently available guidelines for the treatment of resistant GH-secreting adenomas.
Conclusions:
In the last few years, in parallel with the increased number of medical options available for the therapy of acromegaly, relevant advances occurred in the understanding of the role of novel molecular and clinical biomarkers in predicting the responsiveness to second-line medical treatments, such as Pegvisomant and Pasireotide LAR, and helping clinicians in the personalization of the follow-up and treatment of resistant somatotroph adenomas. The integration of these findings into the existing guidelines may represent a possibly important step forward in the management of "difficult" acromegaly patients.
Insights
Treatment resistance in acromegaly, specifically somatotroph adenomas, remains a challenge. Novel biomarkers are emerging to personalize medical therapies like Pegvisomant and Pasireotide LAR for better patient outcomes.
Area of Science:
- Endocrinology
- Oncology
- Pharmacology
Background:
- Acromegaly treatment aims to normalize biochemical values, reduce pituitary mass, and control disease activity using a multidisciplinary approach.
- Despite advancements, many patients have somatotroph adenomas resistant to treatment, leading to persistent active disease and poor outcomes.
Purpose of the Study:
- To review the definition, pathophysiology, and medical treatment options for acromegaly treatment resistance.
- To explore the role of novel clinical and molecular biomarkers in personalizing therapy for resistant GH-secreting adenomas.
- To propose updates to current treatment guidelines for difficult acromegaly cases.
Main Methods:
- Literature review focusing on acromegaly treatment resistance.
- Analysis of novel medical treatment options and biomarkers.
- Evaluation of current treatment guidelines.
Main Results:
- Advances in understanding treatment resistance have led to new medical options.
- Novel biomarkers are showing promise in predicting response to second-line treatments like Pegvisomant and Pasireotide LAR.
- Personalized follow-up and treatment strategies are becoming more feasible.
Conclusions:
- Integrating biomarker findings into guidelines can improve management of resistant somatotroph adenomas.
- Personalized therapy holds potential for better outcomes in difficult acromegaly cases.
- Further research into biomarkers and treatment strategies is warranted.
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