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1Department of Endocrinology and Metabolism, Kyung Hee University School of Medicine, Seoul, Korea.
2Department of Endocrinology, Yonsei University College of Medicine, Seoul, Korea.
3Division of Endocrinology, Department of Internal Medicine, Gachon University College of Medicine, Incheon, Korea.
4Division of Endocrinology and Metabolism, Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Korea.
5Division of Endocrinology and Metabolism, Department of Medicine, Konkuk University School of Medicine, Seoul, Korea.
6Department of Internal Medicine, Cheil General Hospital & Women's Healthcare Center, Dankook University College of Medicine, Seoul, Korea.
7Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.
8Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea.
9Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
10Division of Geriatrics, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
11Division of Endocrinology and Metabolism, Department of Internal Medicine, Research Institute of Clinical Medicine of Chonbuk National University and Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea.
12Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, Korea.
13Department of Internal Medicine, Dongguk University College of Medicine, Gyeongju, Korea.
14Department of Internal Medicine, International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, Korea.
15Department of Internal Medicine, Inje University College of Medicine, Busan, Korea.
16Division of Endocrinology, Department of Internal Medicine, Wonkwang University Sanbon Hospital, Wonkwang University School of Medicine, Gunpo, Korea.
17Division of Endocrinology and Metabolism, Department of Internal Medicine, Chosun University College of Medicine, Gwangju, Korea.
18Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea.
19Division of Endocrinology and Metabolism, Department of Internal Medicine, Sejong General Hospital, Bucheon, Korea.
Copyright © 2019 Korean Endocrine Society
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
(1) Medical treatment using somatostatin analogues in acromegaly may be initiated when serum GH concentrations are not reduced to 1 µg/L or lower based on the 75-g oral glucose tolerance test 3 months after surgery. Treatment goals are to reduce the tumor size, to maintain GH and IGF-1 within normal ranges and as well as to improve the clinical symptoms and signs (A).
(1) The initial dose of octreotide long-acting release (LAR) is 20 mg, administered by intramuscular injection at 4-week intervals. If octreotide LAR fails to suppress serum GH concentrations below 2.5 µg/L after the first 3 months of use, the dose may be increased to 30 mg every 4 weeks. The maximum dose is 40 mg every 4 weeks. If serum GH concentrations remained suppressed below 1 µg/L after administering 20 mg octreotide LAR every 4 weeks for 3 months or longer, and the presenting symptoms and signs of disease are alleviated, the dose may be reduced to 10 mg every 4 weeks (B).
(2) Lanreotide autogel (ATG) can be administered at an initial dose of 60, 90, or 120 mg every 4 weeks. If serum GH concentrations are not reduced below 2.5 µg/L after administration of 60 or 90 mg every 4 weeks for 3 months, the dose may be gradually increased to a maximum of 120 mg every 4 weeks (B).
(3) The initial dose of pasireotide LAR is 40 mg every 4 weeks. If serum GH concentrations are not suppressed after the first 3 months of treatment, the dose may be increased to 60 mg every 4 weeks (B).
(1) When one somatostatin analogue is switched to another in order to improve the biochemical profile and reduce adverse effects, the new drug should be administered at the initial dose outlined in Section 2, above (E).
(2) When switching from octreotide LAR to lanreotide ATG, lanreotide ATG can be administered at 60, 90, or 120 mg regardless of the previous dosage of octreotide LAR. When switching from lanreotide ATG to octreotide LAR, the initial dose of octreotide LAR should be 20 mg every 4 weeks (E).
(1) For patients whose GH concentrations have been reduced below 2.5 µg/L and clinical symptoms are controlled when administered octreotide LAR or lanreotide ATG for 3 months or longer, the dose interval may be extended to 8 weeks by switching to 120 mg of lanreotide ATG regardless of the dose of somatostatin analogue previously administered (C).
(1) Metformin is the preferred treatment for patients who become hyperglycemic during somatostatin analogue therapy, especially with pasireotide LAR. Dipeptidyl-peptidase-4 inhibitors or glucagon-like peptide-1 receptor agonists are also recommended (E).
(2) Use of contraception when somatostatin analogues are administered and discontinuation of somatostatin analogues if pregnancy is considered are recommended (E).
CONFLICTS OF INTEREST: No potential conflict of interest relevant to this article was reported.