Acromegaly is a chronic multisystem disease caused by excessive secretion of growth hormone (GH) and elevated levels of insulinlike growth factor (IGF-I). Note that the earliest description of this pathology dates back to 1516 [1]. However, despite the long history of studying acromegaly and the broad arsenal of modern treatment methods, complete clinical and laboratory remission is relatively rare. Thus, Belaya Zh.E. et al. [2] point out that as of February 2019, only 32 % of patients in Russia had complete clinical and laboratory remission of the disease (IGF-I normalization). In this regard, the search for ways to manage patients with this disease becomes relevant, which determined the purpose of this study — analysis of treatment options for patients with persistent and recurrent acromegaly.

The MedLine, PubMed, and CochraneLibrary databases were searched for keywords (acromegaly, surgical treatment, growth hormone, radiation therapy, drug therapy) among papers published between January 1998 and December 2020.

Findings and Discussion

Before proceeding to a review of current research, the concepts of persistent and recurrent acromegaly must be defined. In this paper, we will define persistent acromegaly as an ineffective treatment, whereas recurrent acromegaly is a return to a state of excess GH after remission.

Note that despite the advances of modern neurosurgery, the cure rate of acromegaly after the first operation has not significantly improved in recent years. Thus, a meta-analysis by Roelfsema F. et al. [3] demonstrated persistent disease in 39 % of patients, while the recurrence rate was only about 3 %. Thus, acromegaly recurrence is less likely than persistent disease. However, in terms of treatment, approaches to persistent or recurrent acromegaly are generally similar. Basic treatment options after ineffective surgery include:

1. Surgical re-intervention.

2. Drug treatment with the use of:

• somatostatin analogues;