What are the treatments for acromegaly?
The aim of treatment is to reduce the level of growth hormone in the blood to normal, and to reduce the size of any enlarged tumour. Many of the symptoms and features of acromegaly will reverse with successful treatment (apart from any fixed extra bone growth that had occurred.)
Surgical treatment
The most common treatment is to remove the adenoma by surgery. This is done using very fine instruments. The surgeon gets to the pituitary gland through a small cut behind the upper lip, just above the front teeth (or sometimes from inside a nostril). The instruments are passed through the base of the skull - the sphenoid bone. Therefore, this operation is called 'trans-sphenoidal surgery', and is done under general anaesthetic. The aim is to remove the adenoma, but to leave the rest of the pituitary gland intact.
The operation is completely successful, with no further treatment needed, in up to 6 in 10 cases. However, sometimes it is not possible to remove all the cells of the tumour. The smaller the tumour, the more likely it can all be removed. If not all is removed, and the growth hormone level remains high following surgery, other treatments listed below are likely to work.
Your surgeon will advise on the possible complications which sometimes occur. For example, sometimes the operation may damage some other parts of the pituitary gland. This may cause a reduced production of some other hormones. If this occurs, you can take replacement hormone therapy. As with any other operation, there are risks from the general anaesthetic.
Medication
Medication can be used if surgery is not possible, or not wanted. It is also used whilst waiting for surgery or radiotherapy. It can also be used in cases where surgery fails to totally remove the tumour and the level of growth hormone remains high.
- Somatostatin analogues (octreotide and lanreotide) reduce the level of growth hormone to normal in over half of cases, and reduce the size of the tumour in about 8 in 10 cases. However, they need to be injected. They work in a similar way to somatostatin (described above) which is a hormone that prevents growth hormone from being released from pituitary cells. These medicines used to be injected several times a day. However, longer-acting preparations are now available as monthly or fortnightly injections. Side-effects are not common with these medicines. Some people develop abdominal pains and diarrhoea, but these usually wear off with time. Gallstones can also occur but rarely cause problems.
- Dopamine agonists (such as cabergoline, bromocriptine and quinagolide) can be taken as tablets. Thy work by preventing the release of growth hormone from tumour cells. However, they only work well in about 1 in 7 cases. Side-effects such as feeling sick and dizzy are also quite common.
- Pegvisomant (Somavert) is a newer treatment. It is taken as a daily injection. However, unlike the other drugs listed above, it does not act directly at the pituitary. Pegvisomant works by blocking the action of growth hormone on the body's cells. Therefore, although many of the symptoms of growth hormone excess will be eased, it does not reduce the size of the tumour and headaches are not eased.
Radiotherapy
Radiotherapy is an option to reduce the size of the tumour and hence reduce the production of growth hormone. Radiotherapy focuses high intensity radiation at your pituitary tumour to destroy the abnormal cells. It may be used if you are not able to have surgery, or if surgery was only partially successful. However, it can take months or years after the radiotherapy is given for the level of growth hormone to reduce to normal. You can take medication whilst waiting for the effects of radiotherapy to work.
A possible side-effect of pituitary radiotherapy is damage to other normal pituitary cells. This can cause a reduced level of some other hormones. However, if this occurs you can take replacement hormone therapy.
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