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Post-Surgical Acromegaly Rx — RACP Adult Medicine MCQ

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HardEndocrinology & DiabetesPost-Surgical Acromegaly RxRACP Adult Medicine

A 50-year-old has persistent acromegaly after maximal safe transsphenoidal surgery. IGF-1 remains twice the upper limit of normal, residual tumour is visible and there is no immediate indication for repeat surgery. Which medical therapy is a usual first choice?

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Correct answer: A — Begin a long-acting first-generation somatostatin-receptor ligand and monitor IGF-1, symptoms and tumour size

The best answer is “Begin a long-acting first-generation somatostatin-receptor ligand and monitor IGF-1, symptoms and tumour size”. Long-acting octreotide or lanreotide is a standard initial medical option for persistent disease and can reduce growth-hormone secretion and tumour volume. Cabergoline is more useful in mild biochemical disease or combination therapy, while pegvisomant is highly effective biochemically but does not shrink tumour and is selected according to phenotype and access. Untreated active disease carries cardiovascular, respiratory and neoplastic risk.

Reference: Australian RACP Adult Medicine: Divisional Written Examination: https://www.racp.edu.au/trainees/examinations/divisional-written-examination Endocrine Society: Acromegaly clinical practice guideline: https://www.endocrine.org/clinical-practice-guidelines/acromegaly