Special features

Acromegaly — treatment options and management

By Anita Banerjee, MBBS, MRCP, Krishna Patel MRPharmS and Alison.M.Wren, MBBS, MRCP

Acromegaly is usually treated by surgery to remove the pituitary adenoma, but adjunctive treatment with drugs and radiotherapy is also necessary. This article describes the treatment options and the importance of long-term monitoring

This article as a FULL TEXT PDF (240K)

Anita Banerjee is specialist registrar, endocrinology and diabetes mellitus
Krishna Patel is lead pharmacist, medicine, and
Alison Wren is consultant in endocrinology

all at Hammersmith Hospitals NHS Trust, London

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The hand of a patient with acromegaly (right) next to that of an adult male of average size

SUMMARY

Acromegaly is an uncommon disorder that develops when the pituitary gland produces too much growth hormone (GH) during adulthood, usually as a result of a pituitary adenoma. It is characterised by a number of somatic, local and metabolic effects as described in the previous article (p273 PDF (1 MB)).

Management of acromegaly may include surgery, radiotherapy, and pharmacological therapy. Treatment is tailored to the individual and may differ depending on tumour size and response to therapy. First-line treatment has traditionally been transsphenoidal surgery (removal of the tumour through the sphenoid sinus) but primary pharmacological therapy with somatostatin analogues may be used in specific cases. This article describes the surgical, radiation and drug treatment options for the condition.

Acromegaly may remain undiagnosed for many years and therefore treatment may be delayed until years after onset of the disease. Studies show that patients with acromegaly who are untreated are more likely to suffer from hypertension, diabetes, stroke and myocardial infarction than the general population, and have a reduced life expectancy.1 The management of a patient with acromegaly should be a multidisciplinary approach involving the endocrinologist, neurosurgeon, radiotherapist and neuroradiologist. The goals of the treatment are:

· To reduce GH production to normal levels

· To relieve the pressure that the pituitary tumour exerts on the surrounding areas which can cause headaches and disturbed vision

· To preserve normal anterior pituitary function

· To reverse or improve symptoms of acromegaly (eg, fatigue, hyperhidrosis)

· To reduce serum insulin-like growth factor –1 (IGF-1) concentration to within the reference range for the patient’s age and gender

· To improve long-term survival

Correction
Krishna Patel was lead author, and not as listed.