La malattia acromegalica : recenti progressi

Acromegaly is a clinical condition characterized by chronic growth hormone (GH) and insulin-like growth factor-I (IGF-I) excess caused in most cases by a somatotroph pituitary adenoma. It is associated to increased mortality, mostly due to cardiovascolar and cerebrovascular diseases, and probably to colon cancer too. Acromegalic patients may have important subjective symptoms and co-morbid systemic illnesses such as arthropaties, skeletal changes, cosmetic disfigurement, severe headache, hypertension and heart diseases, diabetes mellitus, goitre, and sleep-apnoea. Regardless of which treatment modality (medical, surgical or radiant) is employed to attenuate GH levels, it has been shown that only lowering of GH to < 2.5 \u3bcg/L restores the life expectancy to that of age-matched population controls. Thus stringent control of GH and IGF-I is a primary therapeutical goal. In recent years great advances in the medical therapy of acromegaly have been performed with the introduction in clinical practice of long-acting somatostatin analogs. GH antagonists, a new revolutionary agent that blocks GH action is now in phase 3 study, and will be soon available. Up to now, however, in most patients trans-sphenoidal surgery remains the cornerstone in the therapy of this disease. In fact it offers the possibility of definitive cure of acromegaly (success-rate 50-60%), it is rapidly effective and safe