Treating acromegaly effectively often relies on a multi-modal strategy that includes surgery, medical therapy, and/or radiation.
Surgical Management of Acromegaly
Surgery should be considered first-line therapy for all acromegaly patients. However, research shows that remission with surgery is based on multiple factors, including whether the patient presents with a macroadenoma or a microadenoma. Patients with a microadenoma have about an 85% chance of remission with surgery, whereas for those with macroadenoma, the chances of remission are lower — about 30%.1 Regardless of tumor type, even if the mass is removed and the patient is initially cured it's important to note that the tumor can grow back –– so ongoing monitoring of growth hormone (GH) and insulin-like growth factor-1 (IGF-1) levels is vital.2
Surgical intervention aims to provide the following:3
- Immediate reduction in GH levels
- Elimination of the tumor mass and reversal of associated symptoms, including headache and visual impairment
- Alleviation of comorbidities such as hypertension, sleep apnea, arthritis, etc.
- Preservation of pituitary function and restoration of endocrine deficits caused by the tumor
- Prevention of tumor recurrence
- Ability to retrieve and test tissue
Transsphenoidal surgery, which is standard treatment and causes less morbidity than transcranial procedures, can be achieved by two approaches. The two different types of transsphenoidal surgery are: 3,4
- Translabial (surgery to reach the pituitary through an incision through the upper lip) which offers the surgeon improved visibility but is more invasive
- Transnasal (surgery to reach the pituitary through the nose) which provides less discomfort for the patient but has limited visibility and may be more appropriate for smaller pituitary tumors
With all surgical approaches in acromegaly, the surgeon's expertise is critical to a successful outcome.
Medical therapy treatment options include:
- Somatostatin Analogues –– Somatostatin, a naturally occurring regulatory peptide, acts on receptors in the pituitary gland, causing an inhibitory effect on the release of many pituitary hormones, including GH.1,2 Scientists developed somatostatin analogues to mimic the body’s own natural behavior in the treatment of acromegaly.2
- Dopamine Agonists –– Proven occasionally effective in selected patients, including those with modestly elevated IGF-1 levels, these agents lower both GH and prolactin levels.5
- GH Receptor Antagonists –– Blocks peripheral IGF-1 and is indicated in patients not controlled by other agents.5
According to the AACE Guidelines, radiation is most commonly used in acromegaly as adjuvant therapy after surgical removal of a tumor.3 However, the full effect of this therapy may not occur for many years.2