Acromegaly: Pathology, Diagnosis and Treatment PDF

Preface

Recent years have seen important advances in nearly all aspects of the management of acromegaly. Molecular and genetic studies have brought us closer to understanding the events that lead to tumorigenesis in sporadic and inherited forms of acromegaly. The criteria for determining disease activity in acromegaly have narrowed in a relatively short period of time and provide a clear yardstick against which we can measure therapeutic efficacy. Long-term outcome studies have shown the undoubted benefits of growth hormone (GH) and insulin-like growth factor-I (IGF-I) normalization in terms of reducing mortality in acromegaly to that of the general population, thus providing an added impetus for seeking strict disease control. Incremental refinements in neurosurgical techniques continue to improve outcomes, particularly when performed by a dedicated pituitary surgeon. Innovations in radiotherapy, such as radiosurgery, also promise to control acromegaly, potentially with a lower attendant risk of adverse events. In addition to the established medical therapies, i.e., long-acting somatostatin analogs and dopamine agonists, a new GH receptor antagonist, pegvisomant, has been introduced, which promises to provide control of IGF-I in nearly all patients. These treatment options, when used either singly or as a part of multimodal therapy, could ensure effective control in all but the most resistant cases of acromegaly.

Acromegaly: Pathology, Diagnosis and Treatment has been written to provide a timely and concise overview of the current management of the disease, and is divided into three broad sections, echoing the title. The first section, Pathology, begins with a timeline that details some of the most important events in the history of the management of acromegaly. This is followed by a description of the normal function of the pituitary and GH–IGF-I axis. The first section ends with an overview of the epidemiology, pathophysiology, and pathological complications of acromegaly. The second section, Diagnosis, concentrates on the clinical, radiological, and hormonal criteria for diagnosing acromegaly, with particular emphasis being placed on the use of modern GH/IGF-I cutoff levels. Treatment, the third section, devotes separate chapters to the relative benefits of the five treatment modalities now available: surgery, somatostatin analogs, a GH-receptor antagonist, dopamine agonists, and radiotherapy.

Acromegaly: Pathology, Diagnosis and Treatment is intended for both specialists and interested general physicians alike, as a broad awareness of the disease is important if it is to be diagnosed and treated as early as possible. This book may also be helpful to endocrinology fellows in training and students at the early stages of their careers, providing information on the care of acromegaly.

Finally, we would like to acknowledge the following for their generosity to us in terms of their time and also for allowing us to reproduce images contained in the book: Dr. Patrick Petrossians of CHU de Lie`ge and Graphmed (Belgium); Dr. Achille Stevenaert of CHU de Lie`ge (Belgium); Mr. Paul Glacken and the Department of Anatomy, Trinity College (Dublin, Ireland); Mr. Vladimir Chichkov (Tampa, Florida, U.S.A.); Dr. K. Kovacs (Toronto, Canada); Dr. J. Trouillas (Lyon, France); Dr. W. de Herder (Rotterdam, The Netherlands); the A¨ gyptisches Museum, Staatliche Museen zu Berlin (Germany); and Cameraphoto Arte (Venice, Italy). Special thanks to Dr. Serena Dura´n for her insightful comments on the content and layout of the manuscript. Our gratitude also goes to the team at Dekker/Taylor & Francis for all of their hard work in making this book a reality. In particular, we would like to thank our commissioning editor, Sandra Beberman, for her tenacity and forbearance throughout the process of completing this publication.