Acromegaly

Diagnosis

Your physician will inquire about your health history and perform a physical examination. Then, he or she might suggest taking the following actions:

• IGF-1 measurement. Your doctor will take a blood sample from you after you’ve fasted for the night in order to determine your blood’s IGF-1 level. IGF-1 levels above normal point to acromegaly.
• Growth hormone suppression test. The most reliable way to confirm an acromegaly diagnosis is using this test. In this test, the amount of GH in your blood is assessed both before and after you consume a sugar-containing preparation (glucose). The glucose drink usually lowers the GH level in patients without acromegaly. Acromegaly, however, causes your GH level to frequently remain high.
• Imaging. To determine the precise location and size of a tumor on your pituitary gland, your doctor could advise an imaging test, such as magnetic resonance imaging (MRI). Your doctor might schedule additional imaging exams to look for nonpituitary cancers if no pituitary abnormalities are visible.

Treatment

The treatment approach for acromegaly is tailored to each individual patient, taking into consideration factors such as the location, size, and characteristics of the tumor, the severity of symptoms, age, and overall health. The primary treatment options typically involve surgical intervention or radiation therapy to remove or reduce the size of the tumor responsible for the symptoms. Additionally, medications may be prescribed to help normalize hormone levels, specifically to lower growth hormone (GH) and insulin-like growth factor-1 (IGF-1) levels.

Depending on the specific health issues related to acromegaly, your doctor may also recommend additional therapies or interventions to help manage the challenges associated with the condition. The goal of treatment is to alleviate symptoms, reduce the tumor size, normalize hormone levels, and improve overall health and quality of life. It is important to consult with your healthcare provider to determine the most appropriate treatment plan for your specific situation.

Surgery

Transsphenoidal surgery is a surgical technique commonly employed to remove the majority of pituitary tumors. During this procedure, the surgeon accesses the pituitary gland by going through the nose. In cases where the tumor causing the symptoms is not located on the pituitary gland, your doctor may recommend a different type of surgery to remove the tumor.

Following tumor removal, especially if the tumor is small, GH levels typically return to normal. This surgical intervention can also help alleviate headaches and vision disturbances caused by the tumor’s pressure on surrounding tissues near the pituitary gland.

In some instances, it may not be possible for the surgeon to remove the entire tumor. If this is the case, even after surgery, GH levels may remain elevated. In such situations, your doctor may suggest additional surgery, medication, or radiation therapy as potential treatment options. The aim is to further manage and reduce GH levels.

Medications

To assist your hormone levels return to normal, your doctor may advise one of the following medications, or a combination of medications:

• Drugs that reduce growth hormone production (somatostatin analogues). Somatostatin, a brain hormone, inhibits the body’s ability to produce GH. Synthetic somatostatin is available as the medications octreotide and lanreotide. One of these medications tells the pituitary gland to make less growth hormone, and it might even shrink a pituitary tumor. Usually, a medical expert will inject these medications once a month into the gluteal muscles in your buttocks.
• Drugs to lower hormone levels (dopamine agonists). Some persons may benefit from a reduction in GH and IGF-1 levels after taking the oral drugs cabergoline and bromocriptine. These medicines might also aid in reducing tumor size. These drugs typically need to be taken in large doses to treat acromegaly, which raises the possibility of side effects. These medications frequently cause nausea, vomiting, stuffy noses, fatigue, dizziness, sleep issues, and mood swings.
• Drug to block the action of GH (growth hormone antagonist). A drug called pegvisomant stops the effects of GH on the body’s tissues. Pegvisomant may be quite helpful for folks who haven’t had significant success with other treatments. The daily injection of this medication can help lower IGF-1 levels and ease symptoms, but it has no effect on GH levels or tumor size.

Radiation

In cases where the surgeon was unable to fully remove the tumor during surgery, your doctor may recommend radiation therapy. Radiation therapy aims to eliminate any remaining tumor cells and gradually reduce GH levels. It is important to note that significant improvement in the symptoms of acromegaly may take several years after initiating radiation therapy.

During radiation therapy, not only GH but also other pituitary hormones may be affected, leading to their decreased production. Regular follow-up appointments with your doctor will likely be necessary to monitor the functionality of your pituitary gland and assess hormone levels. This ongoing care may be required for the rest of your life to ensure proper management of the condition.

Various radiation therapy forms include:

• Conventional radiation therapy. Over the course of four to six weeks, this kind of radiation therapy is typically administered every working day. For ten or more years following treatment, conventional radiation therapy may not have its full impact.
• Stereotactic radiosurgery. In stereotactic radiosurgery, a high radiation dose is given to the tumor cells while the radiation exposure to healthy surrounding tissues is kept to a minimum. Usually, it can be given in a single dose. Within five to ten years, this kind of radiation may return GH levels to normal.