Personalised acromegaly treatment: implementing precision medicine in the Gulf States

Acromegaly management in the Gulf region is complicated by a high burden of metabolic comorbidity, frequent presentation with macroadenomas and suboptimal biochemical control in available regional cohorts. Conventional first-generation somatostatin receptor ligands achieve biochemical control in only 30-40% of patients, rates lower than those observed in European cohorts, necessitating precision medicine strategies. MRI signal and tumour granulation patterns represent the most widely available biomarkers in Gulf healthcare systems and enable precise treatment selection. These biomarkers may help predict poor first-generation therapy response while identifying patients who may benefit from pasireotide, an efficacious second-generation somatostatin receptor ligand with multi-receptor binding capacity. Implementation of biomarker-guided therapy in Gulf healthcare systems can optimize therapeutic outcomes while addressing regional challenges of delayed diagnosis and advanced disease presentation. Regional challenges specific to Gulf healthcare systems are identified and a practical biomarker-guided algorithm tailored for the GCC region is proposed to optimise treatment selection using readily available diagnostic tools. This approach is more appropriate for Gulf populations who present with more advanced disease characteristics that may benefit from precision-guided first-line treatment selection, representing a paradigm shift away from current guideline recommendations toward truly personalised medicine. This evolution from empirical to precision medicine represents a potential advancement for improving acromegaly management where complex metabolic phenotypes demand sophisticated treatment strategies.