ISSN ONLINE: 2558-815X
ISSN PRINT: 1584-9244
ISSN-L: 1584-9244

New cross-roads for second line medical therapy in acromegaly

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ABSTRACT
Acromegaly is a complex disorder caused by growth hormone excess mostly due to a pituitary adenoma. Surgery represents the first option but rate of long time success is almost 50% thus the patients need other therapies. Apart from radiation, medical therapy panel includes previously used long-acting formulas of first-generation somatostatin analogues like ocreotide or lanreotide and, moreover, pasireotide LAR which is a recently introduced second-generation analogue. Non responders to prior medication, proved a good response to this as pointed by C2305 extension trial or PAOLA study. The rate of overresponse to pasireotide may be explained by a different receptor target: mostly on somatostatin receptor type 5 opposite to type 2 as it acts first-generation compounds. The tolerance of pasireotide LAR is good; the safety profile includes the awareness of hyperglycaemia risk. The cross-road that follows the lack of acromegaly control after a patient was treated with somatostatin analogue of first generation is currently more complex since pasireotide LAR became a feasible option.
Key words: acromegaly, pasireotide LAR, pituitary gland, tumour, glycaemia.

Abbreviations
EMA = European Medicines Agency
FDA = Food and Drug Administration
GH = Growth Hormone
IGF1 = Insulin-like Growth Factor
OGTT = Oral Glucose Tolerance Test
SSTR = Somatostatin Receptor

INTRODUCTION
Acromegaly, a complex condition, caused in 95% of cases by a GH (Growth Hormone) secretor pituitary adenoma, includes metabolic, cardiovascular, and bone anomalies, as well as pituitary tumour-related syndrome due to large hypophyseal masses1-3. This particular complication impairs the growth and final height, and also adequate puberty-associated sexualisation, if the onset is early in life4,5. First-line therapy, as well as most of the pituitary secretor and non-secretor adenomas, except for prolactinomas, is pituitary surgery, but the rate of persistence or recurrence is relatively high.

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