Acromegaly: current therapies benefits and burdens

Chris Yedinak*, Karen J. Pulaski-Liebert, Daphne T. Adelman & Jessica Williams

Acromegaly, caused by growth hormone overproduction, is associated with comorbidities causing significant clinical dysfunction and high mortality risk. Outcomes are hampered by late diagnosis and poor treatment tolerance and adherence. The goal of this paper is to present a scoping review of the benefits and characterize potential burdens of current treatments that may limit achieving disease control or treatment continuity. Current treatments include transsphenoidal surgery, often followed by the use of synthetic somatostatin analogues or growth hormone receptor antagonists. Radiotherapy is considered an adjunct to treatment for nonresponsive patients or recurrent tumors. Despite therapeutic benefits the burdens to the patient equate to an estimated one quarter of patients discontinuing treatment or that are lost to follow up with up to 88% of these cases having uncontrolled disease. Although disease outcomes are improved with early disease identification and prompt treatment, attention to long term treatment adherence is critical to outcomes. The most cost effective and efficacious strategies involve a significant understanding of the individual patient’s disease and treatment burdens, the patient’s knowledge regarding their disease and the full utilization of all health care team resources. Provider awareness of factors impacting follow-up, the application of precision medicine and implementation of a team approach that actively involves the patients, nurses, and physicians in treatment decisions, location convenient disease monitoring with coordination of treatment for co-morbidities and home drug administration are key factors in facilitating long term treatment adherence.