Hypothesis: Extra-hepatic acromegaly: a new paradigm?

S.J.C.M.M. Neggers, JJ Kopchick, JOL Jorgensen, AJ (Aart-Jan) van der Lely

Research output: Contribution to journalArticleAcademicpeer-review

55 Citations (Scopus)


Medical treatment of acromegaly with long-acting somatostatin analogs (LA-SMSA) and the GH receptor antagonist, pegvisomant (PEGV), has made it possible to achieve normal serum IGF1 concentrations in a majority of patients with acromegaly. These two compounds, however, impact the GH-IGF1 axis differently, which challenges the traditional biochemical assessment of the therapeutic response. We postulate that LA-SMSA in certain patients normalizes serum IGF1 levels in the presence of elevated GH actions in extra-hepatic tissues. This may result in persistent disease activity for which we propose the term extra-hepatic acromegaly. PEGV, on the other hand, blocks systemic GH actions, which are not necessarily reliably reflected by serum IGF1 levels, and this treatment causes a further elevation of serum GH levels. Medical treatment is therefore difficult to monitor with the traditional biomarkers. Moreover, the different modes of actions of LA-SMSA and PEGV make it attractive to use the two drugs in combination. We believe that it is time to challenge the existing concepts of treatment and monitoring of patients with acromegaly.
Original languageUndefined/Unknown
Pages (from-to)11-16
Number of pages6
JournalEuropean Journal of Endocrinology
Issue number1
Publication statusPublished - 2011

Research programs

  • EMC MM-01-39-01
  • EMC MM-01-39-04

Cite this