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Goals of Treatment
for Acromegaly

Acromegaly requires a comprehensive strategy for effective management. As a result of the multi-faceted and elusive nature of the disease, acromegaly must be addressed from various angles to eliminate morbidities and reduce the risk of mortality.



Specifically, the goals of treating acromegaly include:
  • Managing the pituitary mass
    • Local tumor growth may lead to symptoms including headache, visual field loss (optic chiasm), and cranial nerve pulses within the cavernous sinus.1
  • Suppressing growth hormone (GH) and insulin-like growth factor-1 (IGF-1) hypersecretion
    • Elevated GH levels are associated with a three-fold increase in morbidity and are the most important determinant of mortality.2
Table 1. Mortality Correlates with GH Levels*
 
Study n GH Level Mortality Ratio (95% CI) P Values
 
 
Bates et al 1993 79 Daily nadir <2.5 ng/mL
Daily nadir >2.5 ng/mL		 1.42 (0.46-3.31)
2.01 (0.9-3.8)		  .28
 .04
Abosch et al 1998 254 Posttreatment <5.0 ng/mL
Posttreatment >5.0 ng/mL		 1.01
3.1		  .51
 <.01
Orme et al 1998 1362 Posttreatment <2.5 ng/mL
Posttreatment ≥10 ng/mL		 1.10 (0.89 - 1.35)
2.12 (1.70 - 2.62)		  
Ayuk et al 2004 419 Posttreatment >2.0 ng/mL 1.55 (0.97-2.50) .07
Holdaway et al 2004 208 Posttreatment <2.0 ng/mL
Posttreatment >5.0 ng/mL		 1.6 (0.9 - 3)
2.6 (1.9 - 3.6)		  
Kauppinen-Mäkelin et al 2005 334 Posttreatment ≥2.5 ng/mL 1.63 (1.10 - 2.35) <.001
 
     

*These studies are not intended to be compared.


  • Achieving control of symptoms
    • The wide range of symptoms associated with acromegaly negatively impact both a patient's daily life and the outlook for his or her long-term health.
  • Alleviating comorbidities
    • The mortality rate among those with acromegaly is two to four times higher than the expected rate due primarily to cardiovascular disease – which is associated with the increased prevalence of hypertension and diabetes mellitus among these patients.1
  • Preserving pituitary function
    • Normalization of pituitary function may help control the symptoms of acromegaly over the long term.2, 3, 4

Multi-modal Treatment Approach

To achieve the multiple goals of therapy, acromegaly often requires a multi-modal approach. Surgery, medical therapy, and radiation are all viable options. Click here to learn more about each of these modalities and how they may impact the course of acromegaly in your patients.



References:
1.
American Association of Clinical Endocrinologists Medical guidelines for clinical practice for the diagnosis and treatment of acromegaly. Endocrine Practice. 2004;10:213-225.
2.
Melmed S, Kleinberg D. Anterior pituitary. In: Larsen PR, Kronenberg HM, Melmed S, Polonsky KS, eds. Williams Textbook of Endocrinology. 10th ed. Philadelphia Pa.: WB Saunders Company; 2003:177-260.
3.
Thorner MO, Vance ML, Laws ER, Horvath E, Kovacs K. The Anterior Pituitary. In: Wilson JD, Foster DW eds. Williams Textbook of Endocrinology. 9th ed. Philadelphia, Pa.: WB Saunders Company; 1998:234–249.
4.
Melmed S, Casanueva FF, Cavagnini F, Chanson P, et al. Consensus guidelines for acromegaly management. J Clin Endocrinol & Metab. 2002;87:4054-4058.
COLLABORATION MAY
IMPROVE CONTROL

Whether you're an endocrinologist,
a primary care physician, or
another specialist such as a
rheumatologist, a cardiologist, or
a dentist — working together as
part of a healthcare team may help
to diagnose and manage your
patients with acromegaly. Click
here for tips on collaborative
disease management.

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