The role of pegvisomant in the treatment of acromegaly.

BACKGROUND

Expert surgery in acromegaly is curative in about only 60% of cases. Postsurgical radiation therapy is associated with a high incidence of hypopituitarism and its effect on growth hormone decrease is slow. Therefore, effective adjuvant medical treatment is mandatory.

OBJECTIVE

To delineate the role of pegvisomant in the treatment of acromegaly.

METHODS

A search of the Medline, Embase and Web of Science databases for clinical studies on pegvisomant was performed. In addition, abstracts of the major endocrine society meetings in 2007 were searched.

RESULTS

When treatment with somatostatin analogues after non-curative surgery does not lead to normalisation of serum IGF-I and growth hormone concentrations, pegvisomant alone or in combination with somatostatin analogues can control disease in a substantial number of patients. The most important side effects are disturbed liver function tests and, rarely, growth of the adenoma. The efficacy in non-operated patients and the long-term safety have yet to be ascertained.