Mortality is increased in individuals with acromegaly unless serum growth hormone (GH) levels are below 2 µg/l and serum insulin-like growth factor (IGF)-I levels are normal following treatment. These combined criteria have been used to define remission of the disorder in this review. Transsphenoidal surgery achieves remission targets in an average of 55% of patients. For those not in remission following surgery, options include repeat surgery or use of adjuvant therapy. Fractionated external beam pituitary radiotherapy achieves 10-year remission rates of 47% but leaves patients exposed to excess GH until remission occurs. Stereotactic radiotherapy and gamma knife radiosurgery achieve remission rates of 40% over 3 years, and dopamine agonists produce remission in about 20% of patients. Somatostatin analogues induce remission in 59% of patients within the first year of treatment. The GH receptor antagonist pegvisomant leads to remission in 90% of patients, using IGF-I levels for assessment. Optimal treatment for a patient with acromegaly thus depends on the likely efficacy of treatment, cost, surgical skill, severity of side effects, tolerability, control of tumour growth, and improvement in complications related to tumour mass. A primary surgical approach, followed by medical therapy for those not in remission, remains the preferred option in most centres.

Keywords:
Acromegaly, Transsphenoidal surgery, Criteria of cure, Radiotherapy, Dopamine agonists, Somatostatin analogues, Pegvisomant
1.
Holdaway IM, Rajasoorya CR, Gamble GD, Stewart AW: Long-term treatment outcome in acromegaly. Growth Hormone and IGF Res 2003;13:185–192.
2.
Giustina A, Barkan A, Casanueva FF, Cavagnini F, Frohman L, Ho K, Veldhuis J, Wass J, Von Werder K, Melmed S: Criteria for cure of acromegaly: A consensus statement. J Clin Endocrinol Metab 2000;85:526–529.
3.
Strasburger CJ: Biochemical assessment and long-term monitoring in patients with acromegaly; statement from a joint consensus conference of the Growth Hormone Research Society and the Pituitary Society, Feldafing, Germany, 30 April–3 May 2003. J Clin Endocrinol Metab 2004;89:3099–3102.
4.
Melmed S, Casanueva FF, Cavagnini F, Chanson P, Frohman L, Grossman A, Ho K, Kleinberg D, Lamberts S, Laws E, Lombardi G, Vance ML, Werder KV, Wass J, Giustina A, Acromegaly Treatment Consensus Workshop Participants: Guidelines for acromegaly management. J Clin Endocrinol Metab 2002;87:4054–4058.
5.
Holdaway IM, Rajasoorya RC, Gamble GD: Factors influencing mortality in acromegaly. J Clin Endocrinol Metab 2004;89:667–674.
6.
Kaltsas GA, Isidori AM, Florakis D, Trainer PJ, Camacho-Hübner C, Afshar F, Sabin I, Jenkins JP, Chew SL, Monson JP, Besser GM, Grossman AB: Predictors of the outcome of surgical treatment in acromegaly and the value of the mean growth hormone day curve in assessing postoperative disease activity. J Clin Endocrinol Metab 2001;86:1645–1652.
7.
Brabant G: Insulin-like growth factor-I: marker for diagnosis of acromegaly and monitoring the efficacy of treatment. Eur J Endocrinol 2003;148:S15–S20.
8.
Freda PU: Current concepts in the biochemical assessment of the patient with acromegaly. Growth Horm IGF Res 2003;13:171–184.
9.
Lissett CA, Peacey SR, Laing I, Tetlow L, Davis JR, Shalet SM: The outcome of surgery for acromegaly: the need for a specialist pituitary surgeon for all types of growth hormone (GH) secreting adenoma. Clin Endocrinol (Oxf) 1998;49:653–657.
10.
Barker FG II, Klibanski A, Swearingen B: Transsphenoidal surgery for pituitary tumors in the United States, 1996–2000: Mortality, morbidity, and the effects of hospital and surgeon volume. J Clin Endocrinol Metab 2003;88:4709–4719.
11.
Arafah BM, Rosenzweig JL, Fenstermaker R, Salazar R, McBride CE, Selman W: Value of growth hormone dynamics and somatomedin C (insulin-like growth factor I) levels in predicting the long-term benefit after transsphenoidal surgery for acromegaly. J Lab Clin Med 1987;109:346–354.
12.
Jenkins D, O’Brien I, Johnson A, Shakespear R, Sheppard MC, Stewart PM: The Birmingham pituitary database: auditing the outcome of the treatment of acromegaly. Clin Endocrinol (Oxf) 1995;43:517–522.
13.
Freda PU, Wardlaw SL, Post KD: Long-term endocrinological follow-up evaluation in 115 patients who underwent transsphenoidal surgery for acromegaly. J Neurosurg 1998;89:353–358.
14.
Risbourg MA, Merle A, Nakib I, Rosseaux P, Colin P, Jolly D, Caron J, Delemer B: Acromegaly: results of 46 patients treated in Reims (France). Abstracts of the 82nd Annual Scientific Meeting of the United States Endocrinology Society, 2000, p 2175.
15.
Biermasz NR, van Dulken H, Roelfsema F: Ten-year follow-up results of transsphenoidal microsurgery in acromegaly. J Clin Endocrinol Metab 2000;85:4596–4602.
16.
Laws ER, Vance ML, Thapar K: Pituitary surgery for the management of acromegaly. Horm Res 2000;53(suppl 3):71–75.
17.
Abe T, Ludecke DK: Effects of preoperative octreotide treatment on different subtypes of 90 GH-secreting pituitary adenomas and outcome in one surgical centre. Eur J Endocrinol 2001;145:137–145.
18.
Kreutzer J, Vance ML, Lopes MB, Laws ER Jr: Surgical management of GH-secreting pituitary adenomas: an outcome study using modern remission criteria. J Clin Endocrinol Metab 2001;86:4072–4077.
19.
Shimon I, Cohen ZR, Ram Z, Hadani M: Transsphenoidal surgery for acromegaly: endocrinological follow-up of 98 patients. Neurosurgery 2001;48:1239–1243;discussion 1244–1245.
20.
Beauregard C, Truong U, Hardy J, Serri O: Long-term outcome and mortality after transsphenoidal adenomectomy for acromegaly. Clin Endocrinol (Oxf) 2003;58:86–91.
21.
De P, Rees DA, Davies N, John R, Neal J, Mills RG, Vafidis J, Davies JS, Scanlon MF: Transsphenoidal surgery for acromegaly in Wales: Results based on stringent criteria of remission. J Clin Endocrinol Metab 2003;88:3567–3572.
22.
Swearingen B, Barker FG II, Katznelson L, Biller BM, Grinspoon S, Klibanski A, Moayeri N, Black PM, Zervas NT: Long-term mortality after transsphenoidal surgery and adjunctive therapy for acromegaly. J Clin Endocrinol Metab 1998;83:3419–3426.
23.
Ciccarelli E, Valetto MR, Vasario E, Avataneo T, Grottoli S, Camanni F: Hormonal and radiological effects of megavoltage radiotherapy in patients with growth hormone-secreting pituitary adenoma. J Endocrinol Invest 1993;16:565–572.
24.
Barkan AL, Halasz I, Dornfeld KJ, Jaffe CA, Friberg RD, Chandler WF, Sandler HM: Pituitary irradiation is ineffective in normalizing plasma insulin-like growth factor I in patients with acromegaly. J Clin Endocrinol Metab 1997;82:3187–3191.
25.
Thalassinos NC, Tsagarakis S, Ioannides G, Tzavara I, Papavasiliou C: Megavoltage pituitary irradiation lowers but seldom leads to safe GH levels in acromegaly: A long-term follow-up study. Eur J Endocrinol 1998;138:160–163.
26.
Powell JS, Wardlaw SL, Post KD, Freda PU: Outcome of radiotherapy for acromegaly using normalization of insulin-like growth factor I to define cure. J Clin Endocrinol Metab 2000;85:2068–2071.
27.
Biermasz NR, van Dulken H, Roelfsema F: Long-term follow-up results of postoperative radiotherapy in 36 patients with acromegaly. J Clin Endocrinol Metab 2000;85:2476–2482.
28.
Barrande G, Pittino-Lungo M, Coste J, Ponvert D, Bertagna X, Luton JP, Bertherat J: Hormonal and metabolic effects of radiotherapy in acromegaly: Long-term results in 128 patients followed in a single center. J Clin Endocrinol Metab 2000;85:3779–3785.
29.
Epaminonda P, Porretti S, Cappiello V, Beck-Peccoz P, Faglia G, Arosio M: Efficacy of radiotherapy in normalizing serum IGF-I, acid-labile subunit (ALS) and IGFBP-3 levels in acromegaly. Clin Endocrinol (Oxf) 2001;55:183–189.
30.
Gutt B, Hatzack C, Morrison K, Pollinger B, Schopohl J: Conventional pituitary irradiation is effective in normalising plasma IGF-I in patients with acromegaly. Eur J Endocrinol 2001;144:109–116.
31.
Landolt AM, Haller D, Lomax N, Scheib S, Schubiger O, Siegfried J, Wellis G: Stereotactic radiosurgery for recurrent surgically treated acromegaly: comparison with fractionated radiotherapy. J Neurosurg 1998;88:1002–1008.
32.
Cozzi R, Barausse M, Asnaghi D, Dallabonzana D, Lodrini S, Attanasio R: Failure of radiotherapy in acromegaly. Eur J Endocrinol 2001;145:717–726.
33.
Brada M, Rajan B, Traish D, Ashley S, Holmes-Sellors PJ, Nussey S, Uttley D: The long-term efficacy of conservative surgery and radiotherapy in the control of pituitary adenomas. Clin Endocrinol 1993;38:571–578.
34.
Asamoah EO, Noren G, Epstein M, Tung G, Rogg J, Jackson IMD: Efficacy of gamma knife radiosurgery in the treatment of pituitary tumors. Abstracts of the 81st Annual Scientific Meeting of the United States Endocrinology Society, 1999;P1–127.
35.
Attanasio R, Epaminonda P, Motti E, Giugni E, Ventrella L, Cozzi R, Farabola M, Loli P, Beck-Peccoz P, Arosio M: Gamma-knife radiosurgery in acromegaly: A 4-year follow-up study. J Clin Endocrinol Metab 2003;88:3105–3112.
36.
Swords FM, Allan CA, Plowman PN, Sibtain A, Evanson J, Chew SL, Grossman AB, Besser GM, Monson JP: Stereotactic radiosurgery XVI: A treatment for previously irradiated pituitary adenomas. J Clin Endocrinol Metab 2003;88:5334–5340.
37.
Pollock BE, Nippoldt TB, Stafford SL, Foote RL, Abboud CF: Results of stereotactic radiosurgery in patients with hormone-producing pituitary adenomas: Factors associated with endocrine normalization. J Neurosurg 2002;97:525–530.
38.
Mitsumori M, Shrieve DC, Alexander E III, Kaiser UB, Richardson GE, Black PM, Loeffler JS: Initial clinical results of LINAC-based stereotactic radiosurgery and stereotactic radiotherapy for pituitary adenomas. Int J Radiat Oncol Biol Phys 1998;42:573–580.
39.
Ikeda H, Jokura H, Yoshimoto T: Transsphenoidal surgery and adjuvant gamma knife treatment for growth hormone-secreting pituitary adenoma. J Neurosurg 2001;95:285–291.
40.
Jadresic A, Jimenez LE, Joplin GF: Long-term effect of 90Y pituitary implantation in acromegaly. Acta Endocrinol (Copenh) 1987;115:301–306.
41.
Feek CM, McLelland J, Seth J, Toft AD, Irvine WJ, Padfield PL, Edwards CR: How effective is external pituitary irradiation for growth hormone-secreting pituitary tumors? Clin Endocrinol (Oxf) 1984;20:401–408.
42.
Eastman RC, Gorden P, Glatstein E, Roth J: Radiation therapy of acromegaly. Endocrinol Metab Clin North Am 1992;21:693–712.
43.
Rajasoorya C, Holdaway IM, Wrightson P, Scott DJ, Ibbertson HK: Determinants of clinical outcome and survival in acromegaly. Clin Endocrinol 1994;41:95–102.
44.
Chon BH, Loeffler JS: Efficacy and risk for radiotherapy in pituitary tumors. Endocrinologist 2002;12:525–530.
45.
Ron E, Modan B, Boice JD Jr, Alfandary E, Stovall M, Chetrit A, Katz L: Tumors of the brain and nervous system after radiotherapy in childhood. N Engl J Med 1988;319:1033–1039.
46.
Brada M, Ford D, Ashley S, Bliss JM, Crowley S, Mason M, Rajan B, Traish D: Risk of second brain tumour after conservative surgery and radiotherapy for pituitary adenoma. Br Med J 1992;304:1343–1346.
47.
Erfurth EM, Bülow B, Mikoczy Z, Svahn-Tapper G, Hagmar L: Is there an increase in second brain tumours after surgery and irradiation for a pituitary tumour? Clin Endocrinol (Oxf) 2001;55:613–616.
48.
Bülow B, Hagmar L, Mikoczy Z, Nordström CH, Erfurth EM: Increased cerebrovascular mortality in patients with hypopituitarism. Clin Endocrinol 1997;46:75–81.
49.
Brada M, Burchell L, Ashley S, Traish D: The incidence of cerebrovascular accidents in patients with pituitary adenoma. Int J Radiat Oncol Biol Phys 1999;45:693–698.
50.
Flickinger JC, Nelson PB, Taylor FH, Robinson A: Incidence of cerebral infarction after radiotherapy for pituitary adenoma. Cancer 1989;63:2404–2408.
51.
Ayuk J, Clayton RN, Sheppard MC, Stewart PM, Bates AS: Cerebrovascular mortality in acromegaly is increased by the use of external radiotherapy and is not predicted by elevated serum IGF-I. Abstracts of the 85th Annual Scientific Meeting of the United States Endocrinology Society, 2003, OR7–6.
52.
Erfurth EM, Bülow B, Svahn-Tapper G, Norrving B, Odh K, Mikoczy Z, Bjork J, Hagmar L: Risk factors for cerebrovascular deaths in patients operated and irradiated for pituitary tumors. J Clin Endocrinol Metab 2002;87:4892–4899.
53.
Tomlinson JW, Holden N, Hills RK, Wheatley K, Clayton RN, Bates AS, Sheppard MC, Stewart PM: Association between premature mortality and hypopituitarism. West Midlands Prospective Hypopituitary Study Group. Lancet 2001;357:425–431.
54.
Rosén T, Bengtsson B-Å: Premature mortality due to cardiovascular disease in hypopituitarism. Lancet 1990;336:285–288.
55.
Bates AS, Van’t Hoff W, Jones PJ, Clayton RN: The effect of hypopituitarism on life expectancy. J Clin Endocrinol Metab 1996;81:1169–1172.
56.
Wass JA: Radiotherapy in acromegaly: A protagonist’s viewpoint. Clin Endocrinol (Oxf) 2003;58:128–131.
57.
Lamberts SW, Uitterlinden P, Verschoor L, van Dongen KJ, del Pozo E: Long-term treatment of acromegaly with the somatostatin analogue SMS 201-995. N Engl J Med 1985;313:1576–1580.
58.
Giusti M, Gussoni G, Cuttica CM, Giordano G: Effectiveness and tolerability of slow release lanreotide treatment in active acromegaly: Six-month report on an Italian multicenter study. Italian Multicenter Slow Release Lanreotide Study Group. J Clin Endocrinol Metab 1996;81:2089–2097.
59.
Stewart PM, Kane KF, Stewart SE, Lancranjan I, Sheppard MC: Depot long-acting somatostatin analog (Sandostatin-LAR) is an effective treatment for acromegaly. J Clin Endocrinol Metab 1995;80:3267–3272.
60.
Freda PU: Somatostatin analogs in acromegaly. J Clin Endocrinol Metab 2002;87:3013–3018.
61.
Ezzat S, Snyder PJ, Young WF, Boyajy LD, Newman C, Klibanski A, Molitch ME, Boyd AE, Sheeler L, Cook DM, Malarkey WB, Jackson I, Vance ML, Thorner MO, Barkan A, Frohman LA, Melmed S: Octreotide treatment of acromegaly. A randomized, multicenter study. Ann Intern Med 1992;117:711–718.
62.
Newman CB, Melmed S, George A, Torigian D, Duhaney M, Snyder P, Young W, Klibanski A, Molitch ME, Gagel R, Sheeler L, Cook D, Malarkey W, Jackson I, Vance ML, Barkan A, Frohman L, Kleinberg DL: Octreotide as primary therapy for acromegaly. J Clin Endocrinol Metab 1998;83:3034–3040.
63.
Amato G, Mazziotti G, Rotondi M, Iorio S, Doga M, Sorvillo F, Manganella G, Di Salle F, Giustina A, Carella C: Long-term effects of lanreotide SR and octreotide LAR on tumour shrinkage and GH hypersecretion in patients with previously untreated acromegaly. Clin Endocrinol (Oxf) 2002;56:65–71.
64.
Cozzi R, Attanasio R, Montini M, Pagani G, Lasio G, Lodrini S, Barausse M, Albizzi M, Dallabonzana D, Pedroncelli AM: Four-year treatment with octreotide-long-acting repeatable in 110 acromegalic patients: predictive value of short-term results? J Clin Endocrinol Metab 2003;88:3090–3098.
65.
Bevan JS, Atkin SL, Atkinson AB, Bouloux PM, Hanna F, Harris PE, James RA, McConnell M, Roberts GA, Scanlon MF, Stewart PM, Teasdale E, Turner HE, Wass JA, Wardlaw JM: Primary medical therapy for acromegaly: An open, prospective, multicenter study of the effects of subcutaneous and intramuscular slow-release octreotide on growth hormone, insulin-like growth factor-I, and tumor size. J Clin Endocrinol Metab 2002;87:4554–4563.
66.
Colao A, Marzullo P, Ferone D, Marino V, Pivonello R, Di Somma C, Di Sarno A, Giaccio A, Lombardi G: Effectiveness and tolerability of slow release lanreotide treatment in active acromegaly. J Endocrinol Invest 1999;22:40–47.
67.
Colao A, Ferone D, Marzullo P, Cappabianca P, Cirillo S, Boerlin V, Lancranjan I, Lombardi G: Long-term effects of depot long-acting somatostatin analog octreotide on hormone levels and tumor mass in acromegaly. J Clin Endocrinol Metab 2001;86:2779–2786.
68.
Ayuk J, Stewart SE, Stewart PM, Sheppard MC: Long-term safety and efficacy of depot long-acting somatostatin analogs for the treatment of acromegaly. J Clin Endocrinol Metab 2002;87:4142–4146.
69.
Turner HE, Vadivale A, Keenan J, Wass JA: A comparison of lanreotide and octreotide LAR for treatment of acromegaly. Clin Endocrinol (Oxf) 1999;51:275–280.
70.
Flogstad AK, Halse J, Bakke S, Lancranjan I, Marbach P, Bruns C, Jervell J: Sandostatin LAR in acromegalic patients: long-term treatment. J Clin Endocrinol Metab 1997;82:23–28.
71.
Lancranjan I, Bruns C, Grass P, Jaquet P, Jervell J, Kendall-Taylor P, Lamberts SW, Marbach P, Ørskov H, Pagani G, Sheppard M, Simionescu L: Sandostatin LAR: A promising therapeutic tool in the management of acromegalic patients. Metabolism 1996;45:67–71.
72.
Lancranjan I, Atkinson AB: Results of a European multicentre study with Sandostatin LAR in acromegalic patients. Sandostatin LAR Group. Pituitary 1999;1:105–114.
73.
Carson MN, Bates PR, Wass JA: Somatostatin analog therapy for acromegaly in clinical practice: a report on behalf of the UK National Acromegaly Study Group. Abstracts of the 83rd Annual Scientific Meeting of the United States Endocrinology Society, 2001, pp 2–190.
74.
Chanson P, Boerlin V, Ajzenberg C, Bachelot Y, Benito P, Bringer J, Caron P, Charbonnel B, Cortet C, Delemer B, Escobar-Jimenez F, Foubert L, Gaztambide S, Jockenhoevel F, Kuhn JM, Leclere J, Lorcy Y, Perlemuter L, Prestele H, Roger P, Rohmer V, Santen R, Sassolas G, Scherbaum WA, Schopohl J, Torres E, Varela C, Villamil F, Webb SM: Comparison of octreotide acetate LAR and lanreotide SR in patients with acromegaly. Clin Endocrinol (Oxf) 2000;53:577–586.
75.
Gilbert J, Ketchen M, Kane P, Mason T, Baister E, Monaghan M, Barr S, Harris PE: The treatment of de novo acromegalic patients with octreotide LAR: Efficacy, tolerability and cardiovascular effects. Pituitary 2003;6:11–18.
76.
Davies PH, Stewart SE, Lancranjan L, Sheppard MC, Stewart PM: Long-term therapy with long-acting octreotide (Sandostatin-LAR) for the management of acromegaly. Clin Endocrinol (Oxf) 1998;48:311–316.
77.
Suliman M, Jenkins R, Ross R, Powell T, Battersby R, Cullen DR: Long-term treatment of acromegaly with the somatostatin analogue SR-lanreotide. J Endocrinol Invest 1999;22:409–418.
78.
Attanasio R, Baldelli R, Pivonello R, Grottoli S, Bocca L, Gasco V, Giusti M, Tamburrano G, Colao A, Cozzi R: Lanreotide 60 mg, a new long-acting formulation: effectiveness in the chronic treatment of acromegaly. J Clin Endocrinol Metab 2003;88:5258–5265.
79.
Chanson P, Leselbaum A, Blumberg J, Schaison G: Efficacy and tolerability of the long-acting somatostatin analog lanreotide in acromegaly. A 12-month multicenter study of 58 acromegalic patients. French Multicenter Study Group on Lanreotide in Acromegaly. Pituitary 2000;2:269–276.
80.
Giusti M, Ciccarelli E, Dallabonzana D, Delitala G, Faglia G, Liuzzi A, Gussoni G, Giordano Disem G: Clinical results of long-term slow-release lanreotide treatment of acromegaly. Eur J Clin Invest 1997;27:277–284.
81.
Baldelli R, Colao A, Razzore P, Jaffrain-Rea ML, Marzullo P, Ciccarelli E, Ferretti E, Ferone D, Gaia D, Camanni F, Lombardi G, Tamburrano G: Two-year follow-up of acromegalic patients treated with slow release lanreotide (30 mg). J Clin Endocrinol Metab 2000;85:4099–4103.
82.
Caron P, Morange-Ramos I, Cogne M, Jaquet P: Three year follow-up of acromegalic patients treated with intramuscular slow-release lanreotide. J Clin Endocrinol Metab 1997;82:18–22.
83.
Heron I, Thomas F, Dero M, Gancel A, Ruiz JM, Schatz B, Kuhn JM: Pharmacokinetics and efficacy of a long-acting formulation of the new somatostatin analog BIM 23014 in patients with acromegaly. J Clin Endocrinol Metab 1993;76:721–727.
84.
al-Maskari M, Gebbie J, Kendall-Taylor P: The effect of a new slow-release, long-acting somatostatin analogue, lanreotide, in acromegaly. Clin Endocrinol (Oxf) 1996;45:415–421.
85.
Marek J, Hana V, Krsek M, Justova V, Catus F, Thomas F: Long-term treatment of acromegaly with the slow-release somatostatin analogue lanreotide. Eur J Endocrinol 1994;131:20–26.
86.
Cannavo S, Squadrito S, Curto L, Almoto B, Vieni A, Trimarchi F: Results of a two-year treatment with slow release lanreotide in acromegaly. Horm Metab Res 2000;32:224–229.
87.
Colao A, Cuocolo A, Marzullo P, Nicolai E, Ferone D, Florimonte L, Salvatore M, Lombardi G: Effects of 1-year treatment with octreotide on cardiac performance in patients with acromegaly. J Clin Endocrinol Metab 1999;84:17–23.
88.
Smith JC, Lane H, Davies N, Evans LM, Cockcroft J, Scanlon MF, Davies JS: The effects of depot long-acting somatostatin analog on central aortic pressure and arterial stiffness in acromegaly. J Clin Endocrinol Metab 2003;88:2556–2561.
89.
Colao A, Marzullo P, Ferone D, Spinelli L, Cuocolo A, Bonaduce D, Salvatore M, Boerlin V, Lancranjan I, Lombardi G: Cardiovascular effects of depot long-acting somatostatin analog Sandostatin LAR in acromegaly. J Clin Endocrinol Metab 2000;85:3132–3140.
90.
Colao A, Cannavo S, Marzullo P, Pivonello R, Squadrito S, Vallone G, Almoto B, Bichisao E, Trimarchi F, Lombardi G: Twelve months of treatment with octreotide-LAR reduces joint thickness in acromegaly. Eur J Endocrinol 2003;148:31–38.
91.
Grunstein RR, Ho KK, Sullivan CE: Effect of octreotide, a somatostatin analog, on sleep apnea in patients with acromegaly. Ann Intern Med 1994;121:478–483.
92.
Garcia-Rio F, Pino JM, Diez JJ, Ruiz A, Villasante C, Villamor J: Reduction of lung distensibility in acromegaly after suppression of growth hormone hypersecretion. Am J Respir Crit Care Med 2001;164:852–857.
93.
Colao A, Ferone D, Cappabianca P, del Basso De Caro ML, Marzullo P, Monticelli A, Alfieri A, Merola B, Cali A, de Divitiis E, Lombardi G: Effect of octreotide pretreatment on surgical outcome in acromegaly. J Clin Endocrinol Metab 1997;82:3308–3314.
94.
Holdaway IM, Wong J, Orr-Walker B, Gamble G: The natural history of treated functional pituitary adenomas; in Webb SM (ed): Pituitary Tumours: Epidemiology, Pathogenesis and Management. Bristol, Bio Scientifica Ltd, 1998, pp 31–42.
95.
Ben-Shlomo A, Melmed S: The role of pharmacotherapy in perioperative management of patients with acromegaly. J Clin Endocrinol Metab 2003;88:963–968.
96.
Barkan AL, Lloyd RV, Chandler WF, Hatfield MK, Gebarski SS, Kelch RP, Beitins IZ: Preoperative treatment of acromegaly with long-acting somatostatin analog SMS 201-995: Shrinkage of invasive pituitary macroadenomas and improved surgical remission rate. J Clin Endocrinol Metab 1988;67:1040–1048.
97.
Stevenaert A, Beckers A: Presurgical octreotide: Treatment in acromegaly. Metabolism 1996;45:72–74.
98.
Biermasz NR, van Dulken H, Roelfsema F: Direct postoperative and follow-up results of transsphenoidal surgery in 19 acromegalic patients pretreated with octreotide compared to those in untreated matched controls. J Clin Endocrinol Metab 1999;84:3551–3555.
99.
Kristof RA, Stoffel-Wagner B, Klingmuller D, Schramm J: Does octreotide treatment improve the surgical results of macro-adenomas in acromegaly? A randomized study. Acta Neurochir (Wien) 1999;141:399–405.
100.
Landolt AM, Haller D, Lomax N, Scheib S, Schubiger O, Siegfried J, Wellis G: Octreotide may act as a radioprotective agent in acromegaly. J Clin Endocrinol Metab 2000;85:1287–1289.
101.
Marzullo P, Ferone D, Di Somma C, Pivonello R, Filippella M, Lombardi G, Colao A: Efficacy of combined treatment with lanreotide and cabergoline in selected therapy-resistant acromegalic patients. Pituitary 1999;1:115–120.
102.
Wass JA, Thorner MO, Morris DV, Rees LH, Mason AS, Jones AE, Besser GM: Long-term treatment of acromegaly with bromocriptine. Br Med J 1977;1:875–878.
103.
Sachdev Y, Gomez-Pan A, Tunbridge WM, Duns A, Weightman DR, Hall R, Goolamali SK: Bromocriptine therapy in acromegaly. Lancet 1975;2:1164–1168.
104.
Quabbe HJ: Treatment of acromegaly by trans-sphenoidal operation, 90-yttrium implantation and bromocriptine: results in 230 patients. Clin Endocrinol 1982;16:107–119.
105.
Jaffe CA, Barkan AL: Treatment of acromegaly with dopamine agonists. Endocrinol Metab Clin North Am 1992;21:713–735.
106.
Abs R, Verhelst J, Maiter D, Van Acker K, Nobels F, Coolens JL, Mahler C, Beckers A: Cabergoline in the treatment of acromegaly: A study in 64 patients. J Clin Endocrinol Metab 1998;83:374–378.
107.
Cozzi R, Attanasio R, Barausse M, Dallabonzana D, Orlandi P, Da Re N, Branca V, Oppizzi G, Gelli D: Cabergoline in acromegaly: A renewed role for dopamine agonist treatment? Eur J Endocrinol 1998;139:516–521.
108.
Jackson SN, Fowler J, Howlett TA: Cabergoline treatment of acromegaly: A preliminary dose finding study. Clin Endocrinol (Oxf) 1997;46:745–749.
109.
Colao A, Ferone D, Marzullo P, Di Sarno A, Cerbone G, Sarnacchiaro F, Cirillo S, Merola B, Lombardi G: Effect of different dopaminergic agents in the treatment of acromegaly. J Clin Endocrinol Metab 1997;82:518–523.
110.
Ferrari C, Paracchi A, Romano C, Gerevini G, Boghen M, Barreca A, Fortini P, Dubini A: Long-lasting lowering of serum growth hormone and prolactin levels by single and repetitive cabergoline administration in dopamine-responsive acromegalic patients. Clin Endocrinol (Oxf) 1988;29:467–476.
111.
Muratori M, Arosio M, Gambino G, Romano C, Biella O, Faglia G: Use of cabergoline in the long-term treatment of hyperprolactinemic and acromegalic patients. J Endocrinol Invest 1997;20:537–546.
112.
Chiodini PG, Attanasio R, Cozzi R, Dallabonzana D, Oppizzi G, Orlandi P, Strada S, Liuzzi A: CV 205–502 in acromegaly. Acta Endocrinol (Copenh) 1993;128:389–393.
113.
Parkinson C, Trainer PJ: The place of pegvisomant in the management of acromegaly. Endocrinologist 2003;13:408–416.
114.
Trainer PJ, Drake WM, Katznelson L, Freda PU, Herman-Bonert V, van der Lely AJ, Dimaraki EV, Stewart PM, Friend KE, Vance ML, Besser GM, Scarlett JA, Thorner MO, Parkinson C, Klibanski A, Powell JS, Barkan AL, Sheppard MC, Malsonado M, Rose DR, Clemmons DR, Johannsson G, Bengtsson B-Å, Stavrou S, Kleinberg DL, Cook DM, Phillips LS, Bidlingmaier M, Strasburger CJ, Hackett S, Zib K, Bennett WF, Davis RJ: Treatment of acromegaly with the growth hormone-receptor antagonist pegvisomant. N Engl J Med 2000;342:1171–1177.
115.
van der Lely AJ, Hutson RK, Trainer PJ, Besser GM, Barkan AL, Katznelson L, Klibanski A, Herman-Bonert V, Melmed S, Vance ML, Freda PU, Stewart PM, Friend KE, Clemmons DR, Johannsson G, Stavrou S, Cook DM, Phillips LS, Strasburger CJ, Hackett S, Zib KA, Davis RJ, Scarlett JA, Thorner MO: Long-term treatment of acromegaly with pegvisomant, a growth hormone receptor antagonist. Lancet 2001;358:1754–1759.
116.
Herman-Bonert VS, Zib K, Scarlett JA, Melmed S: Growth hormone receptor antagonist therapy in acromegalic patients resistant to somatostatin analogs. J Clin Endocrinol Metab 2000;85:2958–2961.
117.
Drake WM, Parkinson C, Akker SA, Monson JP, Besser GM, Trainer PJ: Successful treatment of resistant acromegaly with a growth hormone receptor antagonist. Eur J Endocrinol 2001;145:451–456.
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2004
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