The choice of treatments in acromegaly depends on its cause. For the large majority of cases caused by pituitary adenomas, treatments include surgery, drug therapy, and radiation therapy.
- Often a combination of these therapies is needed to put the disease in remission. ("Remission" here means to return levels of growth hormone and IGF-1 to normal.) No one combination of therapies works best for everyone. Surgery is usually the first approach.
- If surgery alone fails to achieve complete remission, drug therapy is given.
- The success of any treatment regimen is measured by checking levels of growth hormone and IGF-1 in the bloodstream.
- IGF-1 or growth hormone measurements, or both, are repeated at intervals to monitor how well your therapy is working.
Radiation therapy usually is reserved for adenomas that are not cured by surgery and drug therapy. Radiation also is used for people who cannot undergo surgery because of other medical problems.
- Radiation treatments are given in 2 forms, external beam and stereotactic.
- External beam treatments are easier but take much longer to work, an average of 7 years.
- Stereotactic radiotherapy takes about 18 months to normalize growth hormone and IGF-1 levels.
- Many people who receive radiation therapy also receive drug therapy.
- About 60% of people who undergo radiation therapy have a normal or nearly normal growth hormone level 10 years after treatment.
- About 60% of people who undergo radiation therapy have permanent loss of pituitary function. These people must take hormone replacement for the rest of their lives.
- Some studies have linked radiation therapy with growth of other tumors.
Hasnain M Khandwala, MD, FRCPC
Arthur B Chausmer, MD, PhD, FACP, FACE, FACN, CNS
Francisco Talavera, PharmD, PhD
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