IGF1 and acromegaly: Although first-generation somatostatin analogs are widely used with considerable clinical efficacy in acromegaly, following unsuccessful surgery or in cases where surgery is not feasible, a substantial percentage of patients remain biochemically uncontrolled and subject to chronically elevated levels of GH and IGF-1.23 The reasons for poor response to first-generation somatostatin analogs are multifactorial, but likely include a low expression of SSTR2.