Summary
Acromegaly is a chronic debilitating disease caused by growth hormone (GH) hypersecretion, usually from a pituitary adenoma. It is frequently diagnosed after many years of active GH hypersecretion, and causes significant morbidity and mortality due to cardiac, pulmonary and musculoskeletal changes. Local complications resulting from the pituitary tumour can also occur. The most important feature that will enable a physician to diagnosis the disease is clinical vigilance. Measurement of elevated plasma mecasermin (insulin-like growth factor I, IGF-I) is the single best test to make the diagnosis. Once the diagnosis is confirmed, a GH-secreting tumour should be sought, by performing a careful magnetic resonance imaging or computed tomography scan of the pituitary gland and hypothalamus.
Therapy is directed at both preventing local complications of the tumour mass as well as normalising GH secretion. Surgical resection of the tumour is almost always the first step in treatment. If GH secretion is not normalised, which is best assessed by determining whether plasma IGF-I returns to the normal range, further treatment with radiation and/or medical therapy is required. Bromocriptine normalises GH in approximately 10% of patients and causes pituitary shrinkage in a similar fraction of patients. Octreotide is considerably more expensive than bromocriptine and is given subcutaneously, but is more effective in both normalising GH secretion and in shrinking tumours. Octreotide treatment of the pituitary tumours prior to surgical resection may be of value, but requires further investigation.
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References
Alexander L, Appleton D, Hall R, Ross WM, Wilkinson R. Epidemiology of acromegaly in the Newcastle region. Clinical Endocrinology 12: 71–79, 1980
Atkinson AB, McKnight JA, McCance DR, Bell PM. Somatostatin analogue (SMS 201–995) in resistant acromegaly: a preliminary report. Hormone Research 33 (Suppl. 1): 7–12, 1990
Barkan AL. Acromegaly: trends in Endocrinology and Metabolism 3: 205–210, 1992
Barkan AL. Acromegaly: diagnosis and therapy. Endocrinology and Metabolism Clinics of North America 18: 177–310, 1989
Barkan AL, Beitins IZ, Kelch RR Plasma IGF-I/SmC in acromegaly: correlation with the degree of growth hormone hypersecretion. Journal of Clinical Endocrinology and Metabolism 67: 69–73, 1988a
Barkan A, Lloyd RV, Chandler WF, Hatfield MK, Gebarski SS, et al. Preoperative treatment of acromegaly with long-acting somatostatin analog SMS 201–995: shrinkage of invasive pituitary macroadenomas and improved surgical cure rate. Journal of Clinical Endocrinology and Metabolism 67: 1040–1048, 1988b
Barkan A, Lloyd RV, Chandler WF, et al. Treatment of acromegaly with SMS 201–995 (Sandostatin): clinical, biochemical and morphologic study. In Lamberts SWJ (Ed.) Sandostatin in the treatment of acromegaly, pp. 103–108, New York, Springer, 1988c
Barzilay J, Heatley GH, Cushing GW. Benign and malignant tumor in patients with acromegaly. Archives of Internal Medicine 151: 1629, 1991
Belforte L, Camanni F, Chiodini PG, Liuzzi A, Massara F, et al. Long-term treatment with 2-Br-alpha-ergocryptine in acromegaly. Acta Endocrinologica 85: 235–248, 1977
Bell PM, Atkinson AB, Hadden DR, Kennedy L, Leslie H, et al. Bromocriptine reduces growth hormone in acromegaly. Archives of Internal Medicine 146: 1145–1149, 1986
Bengtsson BA, Eden S, Ernest I, Oden A, Sjogren B. Epidemiology and long-term survival in acromegaly. A study of 166 cases diagnosed between 1955 and 1984. Acta Medica Scandinavica 223: 327–335, 1988
Benker G, Sandmann K, Tharandt L, Hackenberg K, Reinwein D. Gel filtration studies of serum growth hormone in acromegaly following bromocriptine administration. Hormone Research 11: 151–160, 1979
Besser GM, Wass JAH, Thorner MO. Bromocriptine in the medical management of acromegaly. In Goldstein et al. (Eds) Advances in Biochemical Psychopharmacology, pp. 191–198, Raven Press, New York, 1980
Bevan JS, Webster J, Burke CW, Scanion MF. Dopamine agonists and pituitary tumor shrinkage. Endocrine Reviews 13: 220–240, 1992
Brockmeier SJ, Buchfelder M, Adams EF, Schott W, Fahlbusch R. Acromegaly with ‘normal’ serum growth hormone levels: clinical features, diagnosis and results of transsphenoidal microsurgery. Hormone and Metabolic Research 24: 392–396, 1992
Camanni F, Massara F, Belforte L, Molinatti GM. Changes in plasma GH levels in normal and acromegalic subjects following administration of 2-Br-alpha-ergocryptine. Journal of Clinical Endocrinology and Metabolism 40: 705–708, 1975
Carlson HE, Levin SR, Braunstein GD, Spencer EM, Wilson SE, et al. Effect of bromocriptine on serum hormones in acromegaly. Hormone Research 19: 142–152, 1984
Casanueva FF. Physiology of growth hormone secretion and action. Endocrinology and Metabolism Clinics of North America 22: 483–517, 1992
Cassar J, Mashiter K, Joplin GF. Bromocriptine treatment of acromegaly. Metabolism 26: 539–546, 1977
Chang-Demoranville BM, Jackson I. Diagnosis and endocrine testing in acromegaly. Endocrinology and Metabolism Clinics of North America 21: 649–668, 1992
Ch’ng LJ, Sandier LM, Kraenzlin ME, Burrin JM, Joplin GF, et al. Long-term treatment of acromegaly with a long-acting analogue of somatostatin. British Medical Journal (Clinical Research Edition) 290: 284–285, 1985
Chanson P, Timsit J, Masquet C, Warnet A, Guillausseau PJ, et al. Cardiovascular effects of the somatostatin analog octreotide in acromegaly. Annals of Internal Medicine 113: 921–925, 1990
Chiba T, Chihara K, Miniamitani N, Goto B, Kadowaki S, et al. Effect of long term bromocriptine treatment on glucose intolerance in acromegaly. Hormone and Metabolic Research 14: 57–61, 1982
Chiodini PG, Cozzi R, Dallabonzana D, Dallabonzana D, Oppizzi G, et al. Medical treatment of acromegaly with SMS 201–995, a somatostatin analog: a comparison with bromocriptine. Journal of Clinical Endocrinology and Metabolism 64: 447–453, 1987
Chiodini PG, Liuzzi A, Botalla L, Oppizzi G, Muller EE, et al. Stable reduction of plasma growth hormone (hGH) levels during chronic administration of 2-Br-alpha-ergocryptine (CB-154) in acromegalic subjects. Journal of Clinical Endocrinology and Metabolism 40: 705–708, 1975
Clayton RN, Vrionides Y, Lynch SS, Butt WR, London DR. Response of acromegaly to long term bromocriptine therapy: a biochemical and clinical assessment. Acta Endocrinologica 89: 469–482, 1978
Clemmons DR, Van Wyk JJ, Ridgway EC, Liman B, Kjellberg RN, et al. Evaluation of acromegaly by radioimmunoassay of somatomedin-C. New England Journal of Medicine 301: 1138–1142, 1979
Comi RJ, Gorden P. The response of serum GH levels to the long-acting somatostatin analog SMS 201–995 in acromegaly. Journal of Clinical Endocrinology and Metabolism 64: 37–42, 1987
Cozzi R, Dallabonzana D, Oppizzi G, Verde G, Liuzzi A, et al. Bromocriptine does not alter growth hormone (GH) responsiveness to GH-releasing hormone in acromegaly. Journal of Clinical Endocrinology and Metabolism 62: 601–604, 1986
Daughaday WH, Starkey RH, Saltman S, Gavin III JR, Mills-Dunlap B, et al. Characterization of serum growth hormone (GH) and insulin-like growth factor I in active acromegaly with minimal elevation of serum GH. Journal of Clinical Endocrinology and Metabolism 65: 617–623, 1987
del Pozo E, Neufeld M, Schlutter K. Endocrine profile of a long-acting somatostatin derivative SMS 201–995. Study in normal volunteers following subcutaneous administration. Acta Endocrinologica 111: 433–439, 1986
Dunn PJ, Donald RA, Espiner EA. Bromocriptine suppression of plasma growth hormone in acromegaly. Clinical Endocrinology 7: 273–281, 1977
Eskildsen PC, Lund B, Sorensen OH, Lund B, Bishop JE, et al. Acromegaly and vitamin D metabolism: effect of bromocriptine treatment. Journal of Clinical Endocrinology and Metabolism 49: 484–486, 1979
Ezzat S, Snyder PJ, Young WF, Boyajy LD, Newman C, et al. Octreotide treatment of acromegaly: a randomized, multicenter study. Annals of Internal Medicine 117: 711–718, 1992
Fahlbusch R, Honegger J, Buchfelder M. Surgical management of acromegaly. Endocrinology and Metabolism Clinics of North America 21: 669–692, 1992
Feek CM, McLelland J, Seth J, Toft AD, Irvine WJ, et al. How effective is external pituitary irradiation for GH-secreting pituitary tumors?. Clinical Endocrinology 20: 401–408, 1984
Fredstorp L, Harris A, Haas G, Werner S. Short term treatment of acromegaly with the somatostatin analog octreotide: the first double-blind randomized placebo-controlled study on its effects. Journal of Clinical Endocrinology and Metabolism 71: 1189–1194, 1990
Giannella-Neto D, Wajchenberg BL, Mendonca BB, Almeida SF, Macchione M, et al. Criteria for the cure of acromegaly: comparison between basal growth hormone and somatomedin C concentrations in active and nonactive acromegalic patients. Journal of Endocrinological Investigation 11: 57–60, 1988
Giustina A, Doga M, Bussi AR, Licini M, Schettino M. Effect of long-term treatment with bromocriptine on the growth hormone response to galanin in patients with acromegaly. Acta Endocrinologica 128: 131–135, 1993
Gross DJ, Halperin Y, Gomori JM, Glaser B. Bromocriptine treatment of acromegaly: possible dose dependency of the tumor size-reducing effect. Israel Journal of Medical Sciences 25: 256–260, 1989
Grossman A, Ross R, Wass JA, Besser GM. Depot-bromocriptine treatment for prolactinomas and acromegaly. Clinical Endocrinology 24: 231–238, 1986
Grunstein RR, Ho KY, Sullivan CE. Sleep apnoea in acromegaly. Annals of Internal Medicine 115: 527–523, 1991
Halse J, Harris AG, Kvistborg A, Kjartansson, O, Hanssen E, et al. A randomized study of SMS 201–995 versus bromocriptine treatment in acromegaly: clinical and biochemical effects. Journal of Clinical Endocrinology and Metabolism 70: 1254–1261, 1990
Halse J, Haugen HN, Bohmer T. Bromocriptine treatment in acromegaly: clinical and biochemical effects. Acta Endocrinologica 86: 464–472, 1977
Hanew K, Sugawara A, Shimizu Y, Sato S, Sasaki A, et al. The combination therapy with bromocriptine and cyproheptadine in patients with acromegaly. Endocrinologia Japonica 36: 429–438, 1989
Harris AG, Prestele H, Herold K, et al. Long-term efficacy of Sandostatin (SMS 201–995, octreotide) in 178 acromegalic patients: results from the international multicentre acromegaly study group. In Lamberts SWJ (Ed.) Sandostatin in the treatment of acromegaly, pp. 117–125, Springer, New York, 1988
Heidvall K, Hulting AL. Rapid progression of a growth hormone producing tumour during dopamine agonist treatment. British Medical Journal 194: 546–547, 1987
Heron I, Thomas F, Dero M, Poutrain JR, Henane S, et al. Treatment of acromegaly with sustained-release lanreotide: a new somatostatin analog. Presse Medicale 22: 526–531, 1993
Ho KY, Jenkins AB, Furier SM, Borkman M, Chisholm DJ. Impact of octreotide, a long-acting somatostatin analogue, on glucose tolerance and insulin sensitivity in acromegaly. Clinical Endocrinology 36: 271–279, 1992
Ho KY, Weissberger MB, Marbach P, Lazarus L. Therapeutic efficacy of the somatostatin analog SMS 201–995 (octreotide) in acromegaly: effects of dose and frequency and long-term safety. Annals of Internal Medicine 112: 173–181, 1990
Holdaway IM, Frengley PA, Scott DJ, Ibbertson HK. Bromoergocryptin treatment of acromegaly persisting following conventional therapy. Clinical Endocrinology 8: 45–54, 1978
Horikawa R, Takano K, Hizuka N, Asakawa K, Sukegawa I, et al. Treatment of acromegaly with long acting somatostatin analogue SMS 201–995. Endocrinologia Japonica 35: 741–751, 1988
Jackson IMD, Barnard L, Cobb W, et al. Long-term treatment of resistant acromegaly with a somatostatin analog (SMS 201–995, Sandostatin). In Lamberts SWJ (Ed.) Sandostatin in the treatment of acromegaly, pp. 133–139, Springer, New York, 1988
Jaffe CJ, Barkan AL. Treatment of acromegaly with dopamine agonists. Endocrinology and Metabolism Clinics of North America 21: 713–735, 1992
James RA, Moller N, Chatterjee S, White M, Kendall-Taylor P. Carbohydrate tolerance and serum lipids in acromegaly before and during treatment with high dose octreotide. Diabetic Medicine 6: 517–523, 1991
James RA, White MC, Chatterjee S, Marciah H, Kendall-Taylor P. A comparison of octreotide delivered by continuous subcutaneous infusion with intermittent injection in the treatment of acromegaly. European Journal of Clinical Investigation 22: 554–561, 1992
Karashima T, Kato K, Nawata H, Ikuyama S, Ibayashi H, et al. Long-term bromocriptine therapy and predictive tests in acromegaly. Endocrinologia Japonica 33: 163–167, 1986
Klein I, Parveen G, Gavaler JS, Van Thiel DH. Colonic polyps in patients with acromegaly. Annals of Internal Medicine 97: 27–30, 1982
Lamberts SWJ, Uitterlinden P, Schuijff PC, Klijn JG. Therapy of acromegaly with Sandostatin: the predictive value of an acute test, the value of serum somatomedin C measurements in dose adjustment and the definition of a biochemical ‘cure’. Clinical Endocrinology 29: 411–420, 1988
Lamberts SWJ, Verleun T, Hofland L, Del Pozo E. A comparison between the effects of SMS 201–995, bromocriptine and a combination of both drugs on hormone release by the cultured pituitary tumour cells of acromegalic patients. Clinical Endocrinology 27: 11–23, 1987
Larrazet F, Spaulding C, Lobreau HJ, Weber S, Guerin F. Possible bromocriptine-induced myocardial infarction. Annals of Internal Medicine 18: 199–200, 1993
Layton MW, Fudman EJ, Barkan AL, Braunstein EM, Fox IH. Acromegalic arthropathy: characteristics and response to therapy. Arthritis and Rheumatism 31: 1022–1027, 1988
Lieberman SA, Bjorkengren AG, Hoffman AR. Rheumatologic and skeletal changes in acromegaly. Endocrinology and Metabolism Clinics of North America 21: 615–631, 1992
Lieberman SA, Hoffman AR. Sequelae to acromegaly: reversibility with treatment of the primary disease. Hormone and Metabolic Research 22: 313, 1990
Lim MJ, Barkan AL, Buda AJ. Rapid reduction of left ventricular hypertrophy in acromegaly after suppression of growth hormone hypersecretion. Annals of Interna Medicine 117: 719–726, 1992
Lindholm J, Riishede J, Verstergaard S, Hummer L, Faber O, et al. No effect of bromocriptine in acromegaly: a controlled trial. New England Journal of Medicine 304: 1450–1454, 1981
Liuzzi A, Chiodini PG, Botalla A, Cremascoli G, Muller EE. Decreased plasma GH levels in acromegalics following CB 154 (2-Br-alpha-ergocryptine) administration. Journal of Clinical Endocrinology and Metabolism 38: 910–912, 1974
Liuzzi A, Chiodini PG, Botalla A, Cremascoli G, Silvestrini F. Inhibitory effect of L-dopa on GH release in acromegalic patients. Journal of Clinical Endocrinology and Metabolism 35: 941–943, 1972
Liuzzi A, Chiodini PG, Cozzi R, et al. Medical treatment of acromegaly. Dopaminergic agonists and long-term somatostatin. In Lamberts SWJ (Ed.) Sandostatin in the treatment of acromegaly, pp. 75–79, Springer, New York, 1988
Lund E, Jorgensen J, Christensen SE, Weeke J, Orskov II, Harris AG. Reduction in sella turcica volume: an effect of long-term treatment with the somatostatin analogue, SMS 201–995, in acromegalic patients. Neuroradiology 33: 162–164, 1991
Lundin L, Ljunghall S, Wide L, Bostrom H. Bromocriptine therapy in eleven patients with acromegaly. Acta Endocrinologica 216 (Suppl.): 207–216, 1978
Maneschi F. Reappraisal of bromocriptine treatment for acromegaly. Hormone Research 12: 191–205, 1980
McGregor AM, Scanion MF, Hall R, Hall K. Effects of bromocriptine on pituitary tumour size. British Medical Journal 2: 700–703, 1979
McKnight JA, McCance DR, Sheridan B, et al. A long-term dose-response study of somatostatin analogue (SMS 201–995, octreotide) in resistant acromegaly. Clinical Endocrinology 34: 119–125, 1991
Mehltretter G, Heinz S, Schopohl J, von Werder K, Müller OA. Long-term treatment with SMS 201–995 in resistant acromegaly: effectiveness of high doses and continuous subcutaneous infusion. Klinische Wochenschrift 69: 83–90, 1991
Melmed S. Acromegaly. New England Journal of Medicine 322: 966–977, 1990
Melmed S. Etiology of pituitary acromegaly. Endocrinology and Metabolism Clinics of North America 21: 539–551, 1992
Merola B, Cittadini A, Colao A, Ferone D, Fazio S, et al. Chronic treatment with somatostatin analog octreotide improves cardiac abnormalities in acromegaly. Journal of Clinical Endocrinology and Metabolism 77: 790–793, 1993
Molitch ME. Clinical manifestations of acromegaly. Endocrinology and Metabolism Clinics of North America 21: 597–614, 1992
Moses AC, Molitch ME, Sawin CT, Jackson IM, Biller BJ, et al. Bromocriptine therapy in acromegaly: use in patients resistant to conventional therapy and effect on serum levels of somatomedin C. Journal of Clinical Endocrinology and Metabolism 53: 752–758, 1981
Nabarro JD. Acromegaly. Clinical Endocrinology 26: 481–512, 1987
Newman C. Long-term treatment of acromegaly with octreotide. Third International Pituitary Congress, Abstract no. MA-41, Marina Del Rey, June 13–15, 1993
Ng LL, Evans DJ. Leucocyte sodium transport in acromegaly. Clinical Endocrinology 26: 471–480, 1987
Nortier JWR, Croughs RJM, Thijsen JHH, Schwarz F. Bromocriptine therapy in acromegaly: effects on plasma GH levels, somatomedin-C levels and clinical activity. Clinical Endocrinology 22: 209–217, 1985
Oppizzi G, Liuzzi A, Chiodini P, Dallabonzana D, Spelta B, et al. Dopaminergic treatment of acromegaly: different effects on hormone secretion and tumor size. Journal of Clinical Endocrinology and Metabolism 58: 988–992, 1984
Oppizzi G, Petroncini MM, Dallabonzana D. Relationship between somatomedin-C and growth hormone levels in acromegaly: basal and dynamic evaluation. Journal of Clinical Endocrinology and Metabolism 63: 1348–1353, 1986
Oyen WJ, Pieters GF, Meijer E, Laarhoven J, et al. Which factors predict the result of pituitary surgery in acromegaly?. Acta Endocrinologica 117: 491–496, 1988
Page MD, Millward ME, Taylor A, Preece M, Hourihan M, et al. Long-term treatment of acromegaly with a long-acting analogue of somatostatin, octreotide. Quarterly Journal of Medicine 274: 189–201, 1990
Pelkonen R, Ylikahri R, Karonen SL. Bromocriptine treatment of patients with acromegaly resistant to conventional therapy. Clinical Endocrinology 12: 219–224, 1980
Pieters GF, van Liessum PA, Smals AG, van Gennep JA, Benraad TJ, et al. Long-term treatment of acromegaly with Sandostatin (SMS 201–995). Normalization of most anomalous GH responses. Acta Endocrinologica 216 (Suppl.): 9–18, 1987
Plewe G, Schrezenmeir J, Nölken G, Krause U, Beyer J, et al. Long-term therapy of acromegaly with the somatostatin analogue SMS 201–995 over 6 months. Klinische Wochenschrift 64: 389–392, 1986
Quabbe HJ. Treatment of acromegaly by trans-sphenoidal operation, 90-yttrium implantation and bromocriptine. Results in 230 patients. Clinical Endocrinology 16: 107–119, 1982
Quabbe HJ, Plöckinger U. Dose-response study and long term effect of the somatostatin analog octreotide in patients with therapy-resistant acromegaly. Journal of Clinical Endocrinology and Metabolism 68: 873–881, 1989
Rajasoorya C, Holdaway IM, Wrightson P, Scott D, Ibbertson HK. Survival and outcome in acromegaly. Third International Pituitary Congress, Abstract no. MA-25, Marina Del Rey, June 13–15,1993
Rieu M, Kuhn J-M, Bricaire H, Luton JP. Evaluation of treated acromegalic patients with normal growth hormone levels during oral glucose load. Acta Endocrinologica 107: 1–8, 1984
Roelfsema F, Frölich M, de Boer H, Harris AG. Octreotide treatment in acromegaly: a comparison between pen-treated and pumptreated patients in a cross-over study. Acta Endocrinologica 125: 43–48, 1991
Roelfsema F, Goslings BM, Frolich M, Moolenaar AJ, Seters AP. The influence of bromocriptine on serum levels of growth hormone and other pituitary hormones and its metabolic effects in active acromegaly. Clinical Endocrinology 11: 235–244, 1979
Ross DA, Wilson CB. Results of transsphenoidal microsurgery for growth hormone-secreting pituitary adenomas in a series of 214 patients. Journal of Neurosurgery 68: 854–867, 1988
Sachdev Y, Gomez-Pan A, Tunbridge WM, Duns A, Weightman DR, et al. Bromocriptine therapy in acromegaly. Lancet 2: 1164–1168, 1975
Salmela PI, Juustila H, Pyhtinen J, Jokinen K, Alavaikko M, et al. Effective clinical response to long term octreotide treatment, with reduced serum concentrations of growth hormone, insulin-like growth factor-I, and the amino-terminal propeptide of type III procollagen in acromegaly. Journal of Clinical Endocrinology and Metabolism 70: 1193–1201, 1990
Salti IS, Istfan N. Bromocriptine fails to stop growth of seosinophilic adenomas in acromegaly. Letter. New England Journal of Medicine 301: 386, 1979
Sandier LM, Burrin JM, Williams G, Joplin GF, Carr DH, et al. Effective long-term treatment of acromegaly with a, long-acting somatostatin analogue (SMS 201–995). Clinical Endocrinology 26: 85–95, 1987
Sano T, Asa SL, Kovacs K. Growth hormone-releasing hormone-producing tumors: clinical, biochemical, and morphological manifestations. Endocrine Reviews 9: 357–373, 1991
Sassolas G, Fossati P, Chanson P. Effects of long-term administration of Sandostatin (SMS 201–995) at increasing doses in 40 acromegalic patients: results from the French Sandostatin acromegaly study group. In Lamberts SWJ (Ed.) Sandostatin in the treatment of acromegaly, pp. 89–94, Springer, New York, 1988
Sassolas G, Harris AG, James-Deidier A. Long term effect of incremental doses of the somatostatin analog SMS 201–995 in 58 acromegalic patients. Journal of Clinical Endocrinology and Metabolism 71: 391–397, 1990
Schatz H, Stracke H, Hildebrandt G. Treatment of prolactinomas and growth hormone-producing adenomas with an injectable bromocriptine retard preparation and a somatostatin analogue delivered by an implantable pump. Pathology Research and Practice 183: 546–551, 1988
Schopohl J, Müller OA, von Werder K. SMS 201–995 (Sandostatin) treatment of therapy-resistant acromegaly. In Lamberts SWJ (Ed.) Sandostatin in the treatment of acromegaly, pp. 153–156, Springer, New York, 1988
Schwinn G, Dirks H, McIntosh C, Kobberling J. Metabolic and clinical studies on patients with acromegaly treated with bromocriptine over 22 months. European Journal of Clinical Investigation 7: 101–107, 1977
Shi YF, Zhu XF, Harris AG, Zhang JX, Dai Q. Prospective study of the long-term effects of somatostatin analog (octreotide) on gallbladder function and gallstone formation in Chinese acromegalic patients. Journal of Clinical Endocrinology and Metabolism 76: 32–37, 1993
Spada A, Arosio M, Bochicchio D, Bazzoni N, Vallar L, et al. Clinical, biochemical, and morphological correlates in patients bearing growth hormone-secreting pituitary tumors with or without consti-tutively active adenylyl cyclase. Journal of Clinical Endocrinology and Metabolism 71: 1421–1426, 1990
Spark RF, Baker R, Bienfang DC, Bergland R. Bromocriptine reduces pituitary tumor size and hypersecretion: requiem for pituitary surgery?. Journal of the American Medical Association 247: 311–316, 1982
Spinas GA, Zapf J, Landolt AM. Preoperative treatment of 5 acromegalics with a somatostatin analogue: endocrine and clinical observations. Acta Endocrinologica 114: 249–256, 1987
Stevenaert A, Beckers A, Kovacs K. Experience with Sandostatin in various groups of acromegalic patients. In Lamberts SWJ (Ed.) Sandostatin in the treatment of acromegaly, pp. 95–101, Springer, New York, 1988
Stevenaaert A, Harris AG, Kovacs K, Beckers A. Presurgical octreotide treatment in acromegaly. Metabolism 41 (Suppl.): 251–58, 1992
Summers VK, Hipkin LJ, Diver MH, Davis JC. Treatment of acromegaly with bromocryptine. Journal of Clinical Endocrinology and Metabolism 40: 904–906, 1975
Tauber P, Babin T, Tauber MT, Vigoni F, Bonafe A, et al. Long term effects of continuous subcutaneous infusion of the somatostatin analog octreotide in the treatment of acromegaly. Journal of Clinical Endocrinology and Metabolism 68: 917–924, 1989
Thorner MO, Chait A, Aitken M, Benker G, Bloom SR, et al. Bromocriptine treatment of acromegaly. British Medical Journal 1: 299–303, 1975
Thuesen L, Christensen SE, Weeke J, Orskov H, Henningsen P. The cardiovascular effects of octreotide treatment in acromegaly: an echocardiographic study. Clinical Endocrinology 30: 619–625, 1989
Timsit J, Chanson P, Larger E, Duet M, Mosse A, et al. The effect of subcutaneous infusion versus subcutaneous injections of a somatostatin analogue (SMS 201–995) on the diurnal GH profile in acromegaly. Acta Endocrinologica 116: 108–112, 1987
Vance ML, Harris AG. Long-term treatment of 189 acromegalic patients with the somatostatin analog octreotide: results of the international multicenter acromegaly study group. Archives of Internal Medicine 151: 1573–1578, 1991
Vance ML, Kaiser DL, Thorner MO. Sandostatin (SMS 201–995) in the treatment of acromegaly. In Lamberts SWJ (Ed.) Sandostatin in the treatment of acromegaly, pp. 149–150, Springer, New York, 1988
Verde GG, Santi I, Chiodini P, Cozzi R, Dallabonzana D, et al. Serum type II procollagen propeptide levels in acromegalic patients. Journal of Clinical Endocrinology and Metabolism 63: 1406–1410, 1986
Wagenaar AH, Harris AG, van der Lely AJ, Lamberts SWJ. Dynamics of the acute effects of octreotide, bromocriptine and both drugs in combination on growth hormone secretion in acromegaly. Acta Endocrinologica 125: 637–642, 1991
Wang C, Lam KSL, Arceo E, Chan FL. Comparison of the effectiveness of 2-hourly versus 8-hourly subcutaneous injections of a somatostatin analog (SMS 201–995) in the treatment of acromegaly. Journal of Clinical Endocrinology and Metabolism 69: 670–677, 1989
Wass JA, Moult PJ, Thorner MO, Dacie JE, Charlesworth M, et al. Reduction of pituitary-tumour size in patients with prolactinomas and acromegaly treated with bromocriptine with or without radiotherapy. Lancet 2: 66–69, 1979
Wass JA, Thorner MO, Morris DV, Rees LH, Mason AS, et al. Long-term treatment of acromegaly with bromocriptine. British Medical Journal 1: 875–878, 1977
Wass JAH, Charlesworth M, Kingsley DPE, et al. A prospective trial of bromocriptine in the treatment of growth hormone secreting tumors. Abstract 2677. Seventh International Congress of Endocrinology, Quebec, Canada, 1984
Wass JAH, Clemmons DR, Underwood LE, Barrow I, Besser GM, et al. Changes in circulating somatomedin-C levels in bromocriptine-treated acromegaly. Clinical Endocrinology 17: 360–377, 1982a
Wass JAH, Davidson K, Medbak S, et al. Somatostatin octapeptide (SMS 201–995, Sandostatin) in the medical treatment of acromegaly. In Lamberts SWJ (Ed.) Sandostatin in the treatment of acromegaly, pp. 151–152, Springer, New York, 1988
Wass JAH, Williams J, Charlesworth MM, Kingsley KP, Halliday AM, et al. Bromocriptine in management of large pituitary tumors. British Medical Journal (Clinical Research Edition) 284: 1908–1911, 1982b
Werner S, Hall K, Sjoberg HE. Bromocriptine therapy in patients with acromegaly: effects on growth hormone, somatomedin A and prolactin. Acta Endocrinologica 216 (Suppl.): 199–206, 1978
Wollesen F, Andersen T, Karle A. Size reduction of extrasellar pituitary tumors during bromocriptine treatment. Annals of Internal Medicine 96: 281–286, 1982
Wright AD, Hill DM, Lowy C, Fraser TR. Mortality of acromegaly. Quarterly Journal of Medicine 39: 1–16, 1970
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Jaffe, C.A., Barkan, A.L. Acromegaly. Drugs 47, 425–445 (1994). https://doi.org/10.2165/00003495-199447030-00004
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DOI: https://doi.org/10.2165/00003495-199447030-00004