How To Treat Acromegaly

Acromegaly is a condition in which the body produces excessive amounts of growth hormones. While the condition most commonly develops during middle age, it can occur in children. The symptoms of acromegaly typically develop over several years, and they can be very subtle. For example, patients might notice their ring or shoe size has increased, and their facial features may enlarge. Some patients also have an enlargement of the internal organs, including the heart. Severe snoring could develop if the airway becomes enlarged, and the voice might deepen or take on a husky quality if the sinuses or vocal cords expand in size. To diagnose acromegaly, doctors typically perform a growth hormone suppression test, and patients will need to have blood tests to measure their levels of IGF-1 and growth hormone. MRI scans might be suggested to look for tumors on the pituitary gland.

The treatment methods described below are often recommended for acromegaly.

Medication

Several types of medication may be used in the treatment of acromegaly. Doctors often prescribe somatostatin analogues such as lanreotide or octreotide to reduce the secretion of excess growth hormones. These medications are typically given as a monthly injection by a healthcare provider. Drugs known as growth hormone antagonists, including pegvisomant, can be taken to block the effects of growth hormones on the body. These drugs are usually taken as daily injections at home, and they are often recommended for patients who have not responded to other medicines. While pegvisomant helps normalize levels of IGF-1 and improve symptom management, the medication does not reduce growth hormone levels, and it cannot shrink any tumors that may be present. Some patients with acromegaly might be able to take oral medicines instead of injections. For example, cabergoline is an oral medication known as a dopamine agonist. Patients who take this medicine could experience a decrease in tumor size, and the medicine can also decrease levels of both IGF-1 and growth hormone. Some patients who use dopamine agonists have developed compulsive behaviors during use, including gambling. Patients may want to discuss this potential side effect with their healthcare team.

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Surgery

Surgery is necessary for patients who have tumors associated with acromegaly. For tumors on the pituitary gland, surgeons typically use a transsphenoidal method for removal, which removes the tumor through the patient's nose. One of the most common types of transsphenoidal surgeries is an endoscopic transnasal transsphenoidal operation. The operation involves inserting surgical instruments through the nostril and along the nasal septum to reach the pituitary gland. The procedure is typically performed by a team that includes a neurosurgeon and an ear, nose, and throat specialist. It is often completed as an inpatient surgery, and requires general anesthesia. After the operation, patients will usually stay in the hospital for one to two days, and symptoms such as nausea, headache, and nasal congestion may be present. Patients should not drive for at least two weeks after the operation, and they should avoid blowing the nose, coughing, sneezing, or drinking with a straw for four weeks after the surgery. Individuals who have had this operation should let their doctor know if they develop a fever above 101 degrees Fahrenheit or if they experience uncontrolled nosebleeds, continual postnasal drip, or breathing difficulties.

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Conventional Radiation

Conventional radiation may be recommended in cases where cancerous cells are still present after surgery. Patients who receive conventional radiation normally have treatment sessions every weekday for a period of four to six weeks. Most sessions take a maximum of twenty minutes, including time for checking in and waiting. During a session, the patient lies down on a table, and a radiologist guides the patient into the precise position needed for the treatment. As the patient lies on the table, external beams of radiation are directed to specific areas of the head. Radiation treatments are painless, and some patients might hear a humming noise while the equipment is running. Fatigue is the most common side effect of conventional radiation, and patients might also notice some hair loss in the treated area. The skin in the area may appear sunburned, and it could become itchy. Some individuals have reported nausea after treatment. Patients who experience skin changes due to radiation should not try to treat these themselves; some over-the-counter products may make skin symptoms worse. Instead, patients should consult with their radiologist about appropriate ways to manage skin symptoms.

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Stereotactic Radiosurgery

As an alternative to conventional radiation, some patients may undergo stereotactic radiosurgery. This treatment involves the delivery of a very high dose of radiation in a single session, and it limits the amount of radiation delivered to surrounding healthy tissues. Patients who receive stereotactic radiosurgery typically experience normalized growth hormone levels within five years of treatment. The procedure lasts between fifteen to sixty minutes, and it is entirely painless and non-invasive. Patients will need to have an intravenous line placed before the procedure so contrast dyes and medicines can be administered, and they will usually be able to go home within one hour after the treatment is completed. Although uncommon, some individuals have experienced swelling of the brain after this procedure. It typically resolves without treatment, and medication or surgery may be needed if it persists.

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Proton Beam Therapy

Proton beam therapy uses protons (positively-charged particles) instead of radiation to destroy cancerous cells. Like radiation, proton beam therapy is painless and noninvasive, and each session takes around fifteen to thirty minutes. Patients normally receive one to five sessions in total. Before each session, the patient will have x-rays or CT scans to ensure they are positioned in the same spot for each treatment, allowing the protons to hit the tumor instead of surrounding tissues. Potential side effects of proton beam therapy are similar to those of radiation and may include fatigue, and skin redness, blistering, peeling, or dryness. Due to the highly specialized equipment needed to deliver proton therapy, it is only available at a few centers around the United States.