Document Detail


Medical therapy in patients with acromegaly: predictors of response and comparison of efficacy of dopamine agonists and somatostatin analogues.
MedLine Citation:
PMID:  19158203     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
CONTEXT: Acromegaly is associated with increased morbidity and mortality. Treatment options include surgery, radiotherapy, and medical therapy. AIMS: The objective of the study was to examine the role of prolactin status, prior surgery, and radiotherapy on the response to medical therapy in patients with acromegaly and assess the relative efficacy of dopamine agonist therapy compared with somatostatin analog therapy. MATERIALS AND METHODS: A total of 276 patients with acromegaly received either dopamine agonists (DA) and/or somatostatin analogs (SSA). One hundred seventy-two patients had received surgery and 73 radiotherapy prior to receiving medical therapy. One hundred ninety-eight of 276 received DA, and 143 of 276 received SSA. GH and IGF-I values at baseline and after 12 months on therapy were analyzed. RESULTS: In the DA group, basal prolactin concentration did not predict response to therapy, GH percent reduction: hyperprolactinemia, 26.7% (-10.4 to 48) vs. normoprolactinemia, 34.8% (0.2-53.2), P = 0.58; IGF-I percent reduction: hyperprolactinemia 30.0% (9.2-43.1) vs. normoprolactinemia 16.8% (4-37), P = 0.45. Prior surgery was not associated with any difference in response to DA: GH percent reduction (P = 0.1) and IGF-I percent reduction (P = 0.08). By contrast, prior radiotherapy was associated with an enhanced efficacy of GH response to DA, P = 0.02. In the SSA group, there was no effect of prior surgery or radiotherapy on response of GH, but radiotherapy was associated with less marked IGF-I percent reduction (P = 0.05). SSA were more potent than DA at decreasing both GH [62.8% (20.7-85%) vs. 42.4% (-6.5 to 68.6), P < 0.008] and IGF-I [SSA 40.4% (0-64.3) vs. 8% (0-40.8), P = 0.05]. CONCLUSIONS: The effects of DA are irrespective of baseline prolactin concentrations. Prior radiotherapy is associated with differences in GH and IGF-I response to DA and SSA therapy.
Authors:
M Sherlock; E Fernandez-Rodriguez; A Aragon Alonso; R C Reulen; J Ayuk; R N Clayton; G Holder; M C Sheppard; A Bates; P M Stewart
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2009-01-21
Journal Detail:
Title:  The Journal of clinical endocrinology and metabolism     Volume:  94     ISSN:  1945-7197     ISO Abbreviation:  J. Clin. Endocrinol. Metab.     Publication Date:  2009 Apr 
Date Detail:
Created Date:  2009-04-07     Completed Date:  2009-05-14     Revised Date:  2009-07-24    
Medline Journal Info:
Nlm Unique ID:  0375362     Medline TA:  J Clin Endocrinol Metab     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1255-63     Citation Subset:  AIM; IM    
Affiliation:
Division of MedicalSciences, Centre for Endocrinology, Diabetes, and Metabolism, University of Birmingham, Birmingham, United Kingdom.
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MeSH Terms
Descriptor/Qualifier:
Acromegaly / blood*,  drug therapy*,  radiotherapy,  surgery
Dopamine Agonists / therapeutic use*
Follicle Stimulating Hormone / deficiency
Human Growth Hormone / blood
Humans
Insulin-Like Growth Factor I / metabolism
Luteinizing Hormone / deficiency
Prolactin / blood
Somatostatin / analogs & derivatives*,  therapeutic use*
Chemical
Reg. No./Substance:
0/Dopamine Agonists; 12629-01-5/Human Growth Hormone; 51110-01-1/Somatostatin; 67763-96-6/Insulin-Like Growth Factor I; 9002-62-4/Prolactin; 9002-67-9/Luteinizing Hormone; 9002-68-0/Follicle Stimulating Hormone
Comments/Corrections
Comment In:
Nat Rev Endocrinol. 2009 Aug;5(8):425-7   [PMID:  19629067 ]

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