How is Acromegaly Treated?

The goals of treatment for acromegaly include removing the tumor or reducing its size, and lowering growth hormone (GH) and insulin-like growth factor-1 (IGF-1) levels to normal.³ These treatments work in different ways to achieve some or all of these goals.

Surgery

Surgical treatment is often the first therapeutic option in patients with acromegaly.

But, depending on the size and location of the tumor, its complete or partial removal is not always possible.⁶ For patients who cannot be operated on—and even for many patients who do have surgery—additional treatment is often needed to help normalize GH and IGF-1 levels.⁶

Medications

The majority of acromegaly patients—including many of those who have had surgery—need to take medication throughout their lives after being diagnosed. Three types of acromegaly medications are available. Like all drugs they cause some side effects. It's important to discuss the possible side effects with your doctor before beginning any treatment.

• Long-acting somatostatin medicines: These drugs work at the source of acromegaly—pituitary tumors—and they work throughout the body and may help provide control of GH and IGF-1 levels.³ These drugs are recommended as first choice of medical therapy for acromegaly by the American Academy of Clinical Endocrinology.³ These typically long-acting forms require injection every 4 weeks.
• GH receptor drugs: This type of drug blocks the effects of GH once it is in the bloodstream and lowers IGF-1 levels.³ It does not work directly at the site of pituitary tumors and doesn't directly reduce excessive GH production. Currently, one GH receptor antagonist is available for prescription and it typically requires daily injections.
• Dopamine medicines: These drugs work on dopamine receptors, which are located within pituitary tumors. While they are used less frequently than the other drugs in managing GH and IGF-1 levels, they can be helpful to some patients.³ They may be used in people with tumors that secrete both GH and prolactin. In general, they are taken orally, once daily.

Note on Switching Medications

Each patient responds differently to different medications, and it's possible that, after starting you on one medication, your doctor may decide to make a change in your prescription.

One or more of the following factors may lead your endocrinologist to recommend switching your medication.

• Your previous medication may not have controlled GH and IGF-1 levels as effectively as your doctor wanted. Just as acromegaly affects each patient differently, medications affect individuals differently, too. Sometimes a switch may improve your response.
• Your previous medication may have been causing difficult side effects.
• The treatment schedule for your previous medication may have been difficult for you to keep up with. If you missed appointments to get your injection and doses were missed, therapy may not have been as effective as possible.
• The cost of your previous medication may have been prohibitive. Financial assistance programs may not have been available to help pay for it, or the programs that were available may not have met your needs.

It's important to discuss the reasons for switching with your doctor.

Radiation

Radiation therapy is sometimes used in addition to surgery when there is a large tumor that extends into the structures next to the pituitary. Since it may take 10-20 years for radiation therapy to be fully effective, patients are also treated with medicines.

Remember: treating acromegaly is a team approach—and you are the most important member of the team.

How Can I Take a More Active Role in My Treatment?

Treating your acromegaly is a team approach: You are the most important member of the team. It's vital that you help take charge of your own care. Every patient's situation is unique in terms of acromegaly symptoms, medical history, treatment, and side effects. It's critical to keep your treatment team informed about what you are experiencing.

Doctors, nurses, support groups, and pharmacists can help you learn about living with acromegaly and your treatment options. Ask plenty of questions, take advantage of support offered by the makers of your medication, and keep track of how you feel throughout the course of therapy.