Assessment of the Impact of Pharmacological Treatment in Acromegaly: A Systematic Review of Metabolic, Clinical, and Psychological Complications

Introduction: Acromegaly is a rare chronic disorder, most often caused by pituitary adenoma, leading to chronically elevated levels of growth hormone (GH) and insulin like growth factor 1 (IGF-1). This hormonal dysregulation results in significant clinical, metabolic, and psychological complications. While transsphenoidal surgery is considered the first-line treatment, it is not always curative or feasible. Pharmacological management has advanced over recent decades, including somatostatin analogues (SSAs), growth hormone receptor antagonists (GHRAs), dopamine agonists (DAs) and combination regimens, aiming to achieve hormonal control and reduce disease burden. This systematic review evaluates the impact of these treatments on acromegaly-related complications within the framework of evidence-based and precision medicine. Methods: A systematic literature search was conducted using PubMed and Google Scholar through May 2025. Eligible studies were Open Access, English-language original research articles evaluating pharmacological interventions in acromegaly and their effects on disease-related complications. A total of twenty-six studies met the inclusion criteria and were selected for analysis. Results: First-generation somatostatin analogs and pegvisomant were found to be effective in reducing IGF-1 levels and improving insulin sensitivity. Pasireotide provided strong biochemical control but was frequently associated with glycemic deterioration. Psychological outcomes showed heterogeneity, however, pegvisomant and combination therapies were linked to higher treatment satisfaction and improved quality of life. Benefits were also observed in cardiovascular, musculoskeletal, and respiratory parameters, although the available data remain limited. Evidence regarding gastrointestinal and oncological complications is insufficient, underscoring significant gaps in current research. Conclusions: Medication-based approaches continue to serve as a primary strategy in managing acromegaly, especially when surgery is not feasible or fails to achieve remission. Despite advancements in medical treatments, a persistent clinical burden remains, highlighting the importance of tailored treatment planning and integrated, multidisciplinary care aligned with the principles of precision medicine.