Modern approach to resistant acromegaly.

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.