Rst-lineprimarytherapy;(b)forindividualstoofrailfor anesthesia;(c)forthosewhodeclinesurgery;(d)preoperativelyto assuremaximalsurgicaloutcomes(109);(e)postoperativelyfor

Rst-lineprimarytherapy;(b)forindividualstoofrailfor anesthesia;(c)forthosewhodeclinesurgery;(d)preoperativelyto assuremaximalsurgicaloutcomes(109);(e)postoperativelyfor persistentandinevitabledisease;(85)or(f)whileawaitingradiotherapyimpacttomanifest.BiochemicalcontrolbyprimarySRLTheJournalofClinicalInvestigation http://www.jci.org Volume119 Number11 Novemberscience in medicineUsingconventionalassays,GHlevelsappeartoincreaseafterdrug administration,likelyduetoattenuationofnegativeIGF1feedbackonsomatotrophsecretion. Efficacy.In177patientsreceivingdailypegvisomantdosesof 100mg,76 achievednormalIGF1levelsafter24months(123), withimprovementofsymptoms,includingsoft-tissueswelling, perspiration,cardiomyopathy,andheartfailure(S38).In75 of patientsresistanttomaximalSRLdoses,pegvisomantnormalizedIGF1levelsandimprovedcardiovascularriskmarkersand insulinsensitivity.PegvisomantisadditivewithSRIFanalogsin controllingIGF1levelsinpatientsresistanttoSRIFalone.In26 patientsreceivingmonthlySRLs,additionofweeklypegvisomant injectionsnormalizedIGF1levelsin95 ofpatients(S39).Therefore, longerdosingintervalsandcombinationtherapyoffereffective pharmacologiccontrolforanoverwhelmingmajorityofpatients. Side effects.About5 ofpatientsreceivingpegvisomantdevelop upto3-foldormoreincreasedhepatictransaminaselevels(123), andthisisinvariablyreversible.Othersideeffectsincludeinjection-sitereactionsandlipohypertrophy,likelyreflectinglocal…