Treatment of Acromegaly

Radiation therapy has been used both as a primary treatment and combined with surgery or drugs. It is usually reserved for patients who have remnants of the tumor even after surgery. Radiation therapy is given in divided doses over four to six weeks. This treatment lowers GH levels by about 50 percent over 2 to 5 years, but it causes a gradual loss of production of other pituitary hormones. Other rare complications associated with radiation therapy are loss of vision and brain injury.

Somatostatin and dopamine analogues and GH receptor antagonists are the mainstays of medical treatment and are generally used after failure of primary surgery to induce complete remission.

Treatment may include removal of the tumor, radiation therapy, and injection of a growth hormone blocking drug.

Tumors that co-secrete prolactin have a better response rate to dopamine agonists. The response to these agents is often detected by a trial of the drug in suitable patients.

The goal of treatment is to restore the pituitary gland to normal function, producing normal levels of growth hormone.

Microsurgery to remove the pituitary tumor causing this condition corrects the abnormal growth hormone secretion in most patients. This surgery may not be available to patients in isolated geographic locations, so travel to a larger metropolitan area may be necessary for treatment.

Which treatment for acromegaly is most effective? 

No single treatment is effective for all patients. Treatment should be individualized, and often combined, depending on patient characteristics such as age and tumor size.
If the tumor has not yet invaded surrounding nonpituitary tissues, removal of the pituitary adenoma by an experienced neurosurgeon is usually the first choice. Even if a cure is not possible, surgery may be performed if the patient has symptoms of neurological problems such as loss of peripheral vision or cranial nerve problems. After surgery, hormone levels are measured to determine whether a cure has been achieved. This determination can take up to 8 weeks because IGF-I lasts a long time in the body’s circulation. If cured, a patient must be monitored for a long time for increasing GH levels. 

If surgery does not normalize hormone levels or a relapse occurs, an endocrinologist should recommend additional drug therapy. With each medication, long-term therapy is necessary because their withdrawal can lead to rising GH levels and tumor re-expansion. 

Radiation therapy is generally reserved for patients whose tumors are not completely removed by surgery, who are not good candidates for surgery because of other health problems, or who do not respond adequately to surgery and medication. 

Acromegaly is a chronic metabolic disorder caused by the presence of too much growth hormone. When this happens, your bones increase in size, including those of your hands, feet and face. Acromegaly affects mostly middle-aged adults. Overproduction of growth hormone is almost always caused by a noncancerous (benign) pituitary tumor (adenoma). This causes abnormal enlargement of bone, cartilage, muscle, organs, and other tissues.  

Other symptoms of acromegaly include thick, coarse, oily skin; skin tags; enlarged lips, nose and tongue; deepening of the voice due to enlarged sinuses and vocal cords; snoring due to upper airway obstruction; excessive sweating and skin odour fatigue and weakness; headaches; impaired vision; abnormalities of the menstrual cycle and sometimes breast discharge in women; and impotence in men. The most serious health consequences of acromegaly are diabetes mellitus, hypertension, and increased risk of cardiovascular disease.  

Patients with acromegaly are also at increased risk for polyps of the colon that can develop into cancer. Acromegaly most commonly affects middle-aged adults and can result in serious illness and premature death. Because of its insidious onset and slow progression, the disease is hard to diagnose in the early stages and is frequently missed for many years.