Preoperative medical therapy for acromegaly: current knowledge and clinical significance

Dan He¹Qinyi Wang¹Guohua Li¹Zhi-Feng Sheng^2*

• ¹Xiangtan Central Hospital, Xiangtan, China
• ²Second Xiangya Hospital, Central South University, Changsha, China

Acromegaly is a chronic endocrine disorder characterized by excessive secretion of growth hormone (GH), predominantly caused by pituitary adenomas. Despite advancements in neurosurgical techniques, the surgical remission rates for invasive macroadenomas or giant adenomas remain unsatisfactory. Therefore, multimodal treatment strategies, including preoperative medical therapy (POMT), have been implemented to improve patient outcomes. Among these, first-generation somatostatin receptor ligands (fg-SRLs) have been the most extensively studied preoperative agents; however, their clinical efficacy in enhancing postoperative remission remains controversial. In recent decades, ongoing research into novel imaging modalities and molecular biomarkers have propelled drug development in this field. Clinical predictive models and functional tests are expected to identify patients most likely to benefit from POMT, particularly those with suboptimal responses to transsphenoidal surgery (TSS). Furthermore, novel SRL formulations and the identification of new molecular targets could further expand the therapeutic landscape of POMT. In this narrative review, we systematically summarize the latest research advancements in POMT for acromegaly and discusses potential therapeutic strategies and persisting obstacles in this field.