Acromegaly

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Diagnosis

A diagnosis of acromegaly is sometimes difficult to make because the development of symptoms occurs slowly over several years. A diagnosis is made based upon a detailed patient history, a thorough clinical evaluation, identification of characteristic findings and specialized tests such as blood tests, a glucose tolerance test, magnetic resonance imaging (MRI) or computerized tomography (CT).

Physicians may test the blood for elevated levels of growth hormone or IGF-1 (insulin growth factor) associated with acromegaly. Measurement of IGF-I is the most accurate available screening blood test. Measurement of growth hormone is often done in conjunction with a glucose tolerance test. During a glucose tolerance test, individuals ingest a specific amount of sugar that should lower GH levels in the blood. In individuals with overproduction of growth hormone, this reduction does not occur.

Physicians may also order an MRI, preferably, or CT scan of the brain to reveal the presence and size of a pituitary tumor. During MRI, a magnetic field and radio waves are used to create cross-sectional images of organs and structures in the body. During CT scanning, a computer and X-rays are used to create a film showing cross-sectional images of an organ’s tissue structure.

Additional tests may be performed to assess the extent of acromegaly in an individual including echocardiography to evaluate whether the heart is involved, tests to determine whether sleep apnea is present and a colonoscopy to assess the health of the colon and establish a baseline for further testing. Patients with acromegaly may be at increased risk for bone fractures, and testing with X-rays or assessment of bone mineral density with a DXA (dual X-ray absorptiometry) scan may be ordered.

Treatment

Acromegaly treatment varies by person. Your treatment plan will likely depend on the location and size of your tumor, the severity of your symptoms, and your age and overall health.


To help lower your GH and IGF-1 levels, treatment options typically include surgery or radiation to remove or reduce the size of the tumor that is causing your symptoms, and medication to help normalize your hormone levels.If you're experiencing health problems as a result of acromegaly, your doctor may recommend additional treatments to help manage your complications.


Surgery

Transnasal transsphenoidal surgery

Endoscopic transnasal transsphenoidal surgeryOpen pop-up dialog box

Doctors can remove most pituitary tumors using a method called transsphenoidal surgery. During this procedure, your surgeon works through your nose to remove the tumor from your pituitary gland. If the tumor causing your symptoms isn't located on your pituitary gland, your doctor will recommend another type of surgery to remove the tumor.

In many cases — especially if your tumor is small — removal of the tumor returns your GH levels to normal. If the tumor was putting pressure on the tissues around your pituitary gland, removing the tumor also helps relieve headaches and vision changes.

In some cases, your surgeon may not be able to remove the entire tumor. If this is the case, you may still have elevated GH levels after surgery. Your doctor may recommend another surgery, medications or radiation treatments.


Medications

Your doctor may recommend one of the following medications — or a combination of medications — to help your hormone levels return to normal:Drugs that reduce growth hormone production (somatostatin analogues). In the body, a brain hormone called somatostatin works against (inhibits) GH production. The drugs octreotide (Sandostatin) and lanreotide (Somatuline Depot) are man-made (synthetic) versions of somatostatin. Taking one of these drugs signals the pituitary gland to produce less GH, and may even reduce the size of a pituitary tumor. Typically, these drugs are injected into the muscles of your buttocks (gluteal muscles) once a month by a health care professional.

Drugs to lower hormone levels (dopamine agonists). The oral medications cabergoline and bromocriptine (Parlodel) may help lower levels of GH and IGF-1 in some people. These drugs may also help decrease tumor size. To treat acromegaly, these medications usually need to be taken at high doses, which can increase the risk of side effects. Common side effects of these drugs include nausea, vomiting, stuffy nose, tiredness, dizziness, sleep problems and mood changes.

Drug to block the action of GH (growth hormone antagonist). The medication pegvisomant (Somavert) blocks the effect of GH on the body's tissues. Pegvisomant may be particularly helpful for people who haven't had good success with other treatments. Given as a daily injection, this medication can help lower IGF-1 levels and relieve symptoms, but it doesn't lower GH levels or reduce tumor size.

Radiation

If your surgeon wasn't able to remove the whole tumor during surgery, your doctor may recommend radiation treatment. Radiation therapy destroys any lingering tumor cells and slowly reduces GH levels. It may take years for this treatment to noticeably improve acromegaly symptoms.Radiation treatment often lowers levels of other pituitary hormones, too — not just GH. If you receive radiation treatment, you'll likely need regular follow-up visits with your doctor to make sure that your pituitary gland is working properly, and to check your hormone levels. This follow-up care may last for the rest of your life.


Types of radiation therapy include:


Conventional radiation therapy. This type of radiation therapy is usually given every weekday over a period of four to six weeks. You may not see the full effect of conventional radiation therapy for 10 or more years after treatment.Stereotactic radiosurgery. Stereotactic radiosurgery uses 3D imaging to deliver a high dose of radiation to the tumor cells, while limiting the amount of radiation to normal surrounding tissues. It can usually be delivered in a single dose. This type of radiation may bring GH levels back to normal within five to 10 years.