Medical Treatment with Somatostatin Analogues in Acromegaly: Position Statement

Abstract

The Korean Endocrine Society (KES) published clinical practice guidelines for the treatment of acromegaly in 2011. Since then, the number of acromegaly cases, publications on studies addressing medical treatment of acromegaly, and demands for improvements in insurance coverage have been dramatically increasing. In 2017, the KES Committee of Health Insurance decided to publish a position statement regarding the use of somatostatin analogues in acromegaly. Accordingly, consensus opinions for the position statement were collected after intensive review of the relevant literature and discussions among experts affiliated with the KES, and the Korean Neuroendocrine Study Group. This position statement includes the characteristics, indications, dose, interval (including extended dose interval in case of lanreotide autogel), switching and preoperative use of somatostatin analogues in medical treatment of acromegaly. The recommended approach is based on the expert opinions in case of insufficient clinical evidence, and where discrepancies among the expert opinions were found, the experts voted to determine the recommended approach.

Approach of Acromegaly during Pregnancy

“…A coordinated team of different specialists is required to treat the associated complications in addition to the targeted approach of the pituitary tumor; this mostly involves selective trans-sphenoidal hypohysectomy as the first line of therapy to address somatotropinoma expansion and GH-IGF1 excess and/or pharmaco-treatment underlying two generations of somatostatin analogues (SSAs)—octreotide, lanreotide, respective pasireotide, dopamine analogues (DAs)—bromocriptine and cabergoline, and GH receptors antagonist—pegvisomant, as well as radiotherapy, especially gamma knife type, in selected cases [ 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 ]. These aspects are detailed in numerous guidelines from different endocrine, surgery and multidisciplinary societies [ 15 , 16 , 17 , 18 , 19 , 23 ]. General increased life expectancy and advanced progress of acromegaly management associate not only a higher number of patients with somatotropinomas among an elderly population and a younger age group at first detection, but also a larger number of women of reproductive age that are potentially able to carry a child and deliver a healthy new-born [ 24 , 25 , 26 , 27 , 28 , 29 ].…”

Comparing MRI volume measurement techniques for pituitary macroadenoma: Investigating volume reduction and its relationship with biochemical control

“…In contrast to the previous guideline on acromegaly, which recommended surgery as the initial treatment approach, our study employed somatostatin receptor ligands as the primary mode of therapy for the first 3-6 months, depending on the individual patient and adenoma characteristics ( Figure 2 ). This approach was chosen due to the ongoing learning curve of our pituitary surgeons, as they have recently started to improve their surgical techniques [ 29 ]. Medical treatment was the primary mode of therapy for functioning adenomas, with more than half of patients with acromegaly and prolactinomas receiving some form of medical therapy, while surgery constituted seventy percent of NFPA management ( Figures 3, 4 ).…”

Severe respiratory failure in a patient with COVID-19 and acromegaly: rapid improvement after adding octreotide

“…Adjunctive treatment for GH hypersecretion typically involves somatostatin analogues, such as octreotide and lanreotide, both preoperatively and postoperatively given the ability of these drugs to reduce secretion of GH from somatotroph cells and thus reduce hepatic production of IGF-1. 16 This is necessary in part because of the difficulty in achieving complete surgical resection of large GH-secreting pituitary adenomas. It has been hypothesised that rapid glycometabolic and immunomodulatory control of untreated acromegaly is key to successful treatment of patients who contract COVID-19, and that somatostatin analogues are the drug of choice for treatment of respiratory failure in such patients given their potentiation of chemoreceptor response to hypoxia.…”