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Endocrine

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15-02-2023 | Acromegaly | Viewpoint

Modern approach to resistant acromegaly

Authors: Andrea Giustina, Luigi di Filippo, Melin M. Uygur, Stefano Frara

Published in: Endocrine | Issue 2/2023

Abstract

Background

Targets of acromegaly treatment are normalization of biochemical values, removal/reduction/stabilization of the pituitary mass, control of clinical activity and mortality with a multimodal/multidisciplinary approach. Despite significant technological and pharmacological progress, still several patients with acromegaly bear a resistant somatotroph adenoma and active disease may persist for many years with resultant poor clinical outcomes.

Aim

To review briefly definition and pathophysiology of resistance to acromegaly treatment and the options of medical treatment in this context, exploring the role of novel clinical and molecular biomarkers in the personalization of therapy and proposing updates to the currently available guidelines for the treatment of resistant GH-secreting adenomas.

Conclusions

In the last few years, in parallel with the increased number of medical options available for the therapy of acromegaly, relevant advances occurred in the understanding of the role of novel molecular and clinical biomarkers in predicting the responsiveness to second-line medical treatments, such as Pegvisomant and Pasireotide LAR, and helping clinicians in the personalization of the follow-up and treatment of resistant somatotroph adenomas. The integration of these findings into the existing guidelines may represent a possibly important step forward in the management of “difficult” acromegaly patients.

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Title: Modern approach to resistant acromegaly
Authors: Andrea Giustina
Luigi di Filippo
Melin M. Uygur
Stefano Frara
Publication date: 15-02-2023
Publisher: Springer US
Keyword: Acromegaly
Published in: Endocrine / Issue 2/2023
Print ISSN: 1355-008X
Electronic ISSN: 1559-0100
DOI: https://doi.org/10.1007/s12020-023-03317-7

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