Acromegaly
Treatment Options

Treating acromegaly effectively often relies on a multimodal strategy that includes surgery, medical therapy, and/or radiation.1

Surgical Management of Acromegaly

Surgery should be considered first-line therapy for most patients with acromegaly. However, research shows that remission with surgery is based on multiple factors, including whether the patient presents with a macroadenoma or a microadenoma.2 Patients with a microadenoma have >85% chance of initial remission with surgery, whereas for those with macroadenoma, the chances of remission are lower—about 40-50%.2 Regardless of tumor type, even if the mass is removed and the patient is initially cured, it's important to note that the tumor can grow back—so ongoing monitoring of growth hormone (GH) and insulin-like growth factor-1 (IGF-1) levels is vital.1

Surgical intervention aims to provide the following2:

  • Immediate reduction in GH levels
  • Elimination of the tumor mass and reversal of associated symptoms, including headache and visual impairment
  • Alleviation of comorbidities such as hypertension, sleep apnea, arthritis, etc
  • Preservation of pituitary function and restoration of endocrine deficits caused by the tumor
  • Prevention of tumor recurrence
  • Ability to retrieve and test tissue

Transsphenoidal surgery, which is standard treatment and causes less morbidity than transcranial procedures, can be achieved by 2 approaches. The 2 different approaches in transsphenoidal surgery are2:

  • Using the operating microscope
  • Using the operating endoscope

With all surgical approaches in acromegaly, the surgeon's expertise is critical to a successful outcome.2

Medical Therapy

Medical therapy treatment options include2:

Radiation Therapy

Radiation is most commonly used in acromegaly as adjuvant therapy after surgical removal of a tumor.2 However, the full effect of this therapy may not occur for many years.2

References:
National Institute of Diabetes and Digestive and Kidney Diseases. Acromegaly. https://www.niddk.nih.gov/health-information/endocrine-diseases/acromegaly#treatment. Accessed April 27, 2017.
Katznelson L, Laws ER Jr, Melmed S, et al. Acromegaly: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2014;99(11):3933-3951.