Acromegaly: Pathology, Diagnosis and Treatment

The intense clinical interest that acromegaly attracts has driven advances in our understanding of the effects of excessive growth hormone (GH) and insulin-like growth factor-I (IGF-I) secretion on various tissues and organ systems. Consequently, diagnostic guidelines and treatment outcomes measures are continuously being refined as new data become available.

David R. Clemmons is Chief of the Division of Endocrinology, University of North Carolina, Chapel Hill, North Carolina, U.S.A.

Preface

iii

SECTION I: Pathology

Acromegaly: A Historical Timeline

3

(26)

Introduction

3

(1)

Prehistory to Imperial Rome

4

(1)

The Middle Ages and the Renaissance

5

(2)

Late 18th to Early 20th Century: Recognition and Description of Acromegaly

7

(8)

Late 19th to Mid-20th Century: Pathology and Treatment

15

(4)

Early 20th Century to Present Day: Physiology and Pharmacotherapy

19

(5)

Conclusion

24

(1)

References

25

(4)

The Pituitary Gland: Normal GH/IGF-I Secretion

29

(10)

Anatomy and Structure of the Pituitary Gland

29

(2)

The Growth Hormone--Insulin-Like Growth Factor-I Axis

31

(4)

References

35

(4)

Epidemiology, Pathology, and Complications of Acromegaly

39

(34)

Epidemiology

39

(1)

Mortality

40

(1)

Pathology: Histopathological Characteristics of Tumors in Acromegaly

41

(9)

Causes of Acromegaly

50

(4)

Complications of Acromegaly

54

(8)

References

62

(11)

SECTION II: Diagnosis

Clinical, Endocrine and Radiologic Diagnosis of Acromegaly

73

(26)

Introduction

73

(1)

Clinical Diagnosis and Workup

73

(10)

Endocrine Diagnosis

83

(2)

Radiologic Diagnosis

85

(6)

References

91

(8)

SECTION III: Treatment

Surgery

99

(10)

Introduction

99

(1)

Technical Approaches to Pituitary Surgery

99

(3)

Preoperative Management

102

(1)

Outcomes of Surgical Treatment of Acromegaly

103

(1)

Repeat Surgery

104

(1)

Adverse Events

105

(1)

References

105

(4)

Somatostatin Analogs

109

(12)

Background

109

(1)

Somatostatin Analogs in Acromegaly: Early Studies

110

(1)

Depot Formulations of Somatostatin Analogs

110

(1)

Efficacy of Long-Acting Somatostatin Analogs

111

(2)

Signs and Symptoms

113

(1)

Tumor Shrinkage

113

(1)

Adverse Events

114

(1)

References

115

(6)

Growth Hormone Receptor Antagonist

121

(14)

The Development of Pegvisomant

121

(2)

Pegvisomant in the Treatment of Acromegaly

123

(4)

Adverse Events

127

(2)

Pegvisomant: Indications for Treatment

129

(1)

References

129

(6)

Dopamine Agonists

135

(6)

Background

135

(1)

Clinical Studies

135

(2)

Adverse Events

137

(1)

References

138

(3)

Radiotherapy

141

(6)

Background

141

(1)

Efficacy of Radiotherapy in Acromegaly

141

(3)

Adverse Events Associated with Radiotherapy in Acromegaly

144

(1)

Summary

145

(1)

References

145

(2)

Index

147

(4)

About the Authors

151

What is included with this book?

The New copy of this book will include any supplemental materials advertised. Please check the title of the book to determine if it should include any access cards, study guides, lab manuals, CDs, etc.

The Used, Rental and eBook copies of this book are not guaranteed to include any supplemental materials. Typically, only the book itself is included. This is true even if the title states it includes any access cards, study guides, lab manuals, CDs, etc.

FREE SHIPPING

Amazon no longer offers textbook rentals. We do!

Acromegaly: Pathology, Diagnosis and Treatment

Summary

Author Biography

Table of Contents

Supplemental Materials