Acromegaly FAQs (cont.)
Kathryn L Hale, MS, PA-C
Hasnain M Khandwala, MD, FRCPC
Arthur B Chausmer, MD, PhD, FACP, FACE, FACN, CNS
Francisco Talavera, PharmD, PhD
George T Griffing, MD
IN THIS ARTICLE
What treatments are available for acromegaly?
There are several treatment options in acromegaly. Whichever treatments are used, the goal is to relieve and reverse the symptoms of the disease. This is done in 2 ways: by normalizing production of growth hormone and IGF-1 and by reducing the effects of the pituitary tumor on the surrounding tissues. A secondary goal is to avoid damaging normal pituitary tissue.
Will I have surgery?
Surgery is usually the first approach to treating acromegaly. For most people, this means removal of the pituitary tumor that is causing overproduction of growth hormone. The tumor is removed through an incision inside the nose. The operation is called transsphenoidal hypophysectomy. While technically not “brain surgery,” this is a very delicate operation calling for an experienced surgeon.
Is surgery a cure for acromegaly?
Surgery alone does bring about remission for some people, but not everyone. “Remission” in this case means to return levels of growth hormone and IGF-1 to normal. Remission is different than cure in that the disease can come back from remission.
If it is successful, this operation quickly relieves symptoms caused by the tumor pressing on adjacent tissue. Remission rates are about 80-85% for small adenomas (microadenomas) and 50-65% for large adenomas (macroadenomas).
People who are in remission after surgery usually need no further treatment. (Some people, however, require lifelong hormone replacement after pituitary surgery.) Growth hormone and IGF-1 levels after surgery usually indicate whether further treatment is needed. If these levels have not returned to normal, other treatment is needed.
What other treatments are available?
Often a combination of treatments is needed to put the disease in remission. No one combination of therapies works best for everyone.
Drug therapy is usually the second treatment. Drugs are given to normalize levels of growth hormone and IGF-1. Some drugs work by blocking production of growth hormone. Others work by preventing the growth hormone from stimulating production of IGF-1. In some cases, drugs are given to shrink the tumor.
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. 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.
What drugs are used to treat acromegaly?
Growth hormone receptor blockers are the newest category of drugs used for acromegaly. These drugs work by blocking the places on cells where growth hormone “docks.” If the excess growth hormone in the blood can’t dock on a cell, it can’t cause abnormal growth of the cell. The only drug in this category that has been approved by the US Food and Drug Administration for acromegaly is pegvisomant (Somavert). In early studies, this drug normalized IGF-1 level in more than 90% of people treated. Pegvisomant is given by a shot every day.
Somatostatin analogues act like a natural hormone called somatostatin, which stops secretion of growth hormone. The most widely used drug in this group by far is octreotide (Sandostatin). This drug works in most people who take it. It can be taken only as shots, either 3 times a day under the skin or once a month in the muscle.
Dopamine agonists promote the activity of dopamine, a chemical in the brain. These drugs work by stopping secretion of growth hormone by some pituitary tumors. The most widely used of these drugs is bromocriptine (Parlodel). It is popular because it comes in a convenient oral form and is much less expensive than octreotide. These drugs generally do not work as well as the growth hormone receptor blockers or the somatostatin analogues.
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