This protocol addresses acromegaly characterised by only modest elevation of serum IGF-1 and mild signs and symptoms of growth hormone excess — a presentation where initial medical therapy was the appropriate first step, but the required biochemical targets have not been achieved.
Initial adjuvant medical therapy with a dopamine agonist — cabergoline (oral) — did not achieve the required targets: age-normalized serum IGF-1 and a random GH below 1.0 µg/L. Failure to reach these specific biochemical goals is what triggers escalation to the next treatment step described here.
The recommended next step involves a combination strategy in which a somatostatin receptor ligand is added to the existing regimen. The complete selection criteria, dosing, monitoring schedule, and sequencing remain in the full structured protocol.
The primary biochemical goal is normalization of serum IGF-1 to an age-appropriate value, which signifies control of acromegaly.
In a patient with only modest elevations of serum IGF-1 and mild signs and symptoms of GH excess, we suggest a trial of a dopamine agonist, usually cabergoline, as the initial adjuvant medical therapy.
This suggests that cabergoline may be added to a SRL, particularly if the GH/IGF-1 levels are mildly elevated.
We suggest a biochemical target goal of an age-normalized serum IGF-1 value, which signifies control of acromegaly.
DOI: 10.1210/jc.2014-2700
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