Treatment Options
The goals of acromegaly treatment are to:
- Eliminate the tumor and prevent recurrence
- Restore and maintain normal pituitary function
- Normalize insulin-like growth factor-1 (IGF-1) and growth hormone (GH) levels (GH <2.5 ng/mL; if possible, lower to 1 ng/mL) in order to reduce the comorbidities and symptoms associated with active acromegaly6
The following treatment options are available for the treatment of acromegaly:
- Surgery is first-line therapy for virtually all patients with acromegaly. It is recommended for GH-secreting microadenomas, as well as for decompressing mass effects on vital structures-particularly the optic tracts.
Surgery may not be indicated in:- Patients that present with an invasive tumor, sinus extension, or suprasellar extension, and whose pituitary lesion does not compress vital structures
- Patients in whom the risks of surgery or anesthesia are unacceptable
- Patients with major systemic manifestations of acromegaly, including cardiomyopathy, severe hypertension, and uncontrolled diabetes
- Patients who refuse surgery8
- Pharmacological treatment may be used as adjunctive therapy in surgery patients before surgery to decrease GH secretion and facilitate the intervention. Also, pharmacological treatment may be indicated after surgery to reduce GH blood levels to normal. Pharmacological treatment may involve:6
- Somatostatin analogs
- GH receptor antagonists
- Dopamine agonists
- Radiation therapy is most commonly used after surgery. Radiation often takes several years to adequately reduce serum levels of GH and IGF-1. Supplemental pharmacologic options are usually used beforehand in an effort to lower GH levels sufficiently; radiation may also be used if surgery involves unacceptable risks.6
