What Are My Treatment Options?
You and your health care professional have 3 main options to choose from when considering the treatment that is right for you:
In most cases, surgery is the therapy of choice for the initial management of acromegaly. If you are not a candidate for surgery, medical treatment is the first-line therapy. The following summarizes key information about each treatment option.
Transsphenoidal Surgery
Surgery is the preferred treatment for most patients. The goal of surgery is to remove the tumor and normalize GH and IGF-1 levels. If successful, hormone control is reestablished. If not, drug therapy may be the next choice.
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A patient healing from transsphenoidal hypophysectomy. (The upper lip is held up to show the incision.)
In this case, the route to the pituitary was via the bridge above the upper teeth, rather than through the nose.
Beckers A. Pituitary Adenomas. An Interactive Resource for Your Library. Basel: Novartis Pharma AG, 2001. |
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Medical Therapy
Somatostatin Analogues (SAs)
When surgery fails, the mainstay for medical treatment is a class of drugs known as somatostatin analogues. SAs are similar to somatostatin, a naturally occurring hormone made by the hypothalamus, except that somatostatin analogues remain in the body much longer than somatostatin. They work directly at the site of the pituitary tumor by shutting off the production of hormones that cause the symptoms of acromegaly. They may also be used instead of surgery in patients at risk for complications from anesthesia, patients with heart or lung complications, or patients whose tumors are large but not next to the optic nerve. Long-acting formulations were preferred by a consensus panel of experts for these patients.
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GH Receptor Antagonist
For select patients, GH receptor antagonists (GHRAs) may be prescribed. These include patients in whom mainstay treatments such as surgery, somatostatin analogues, and dopamine agonists have proven ineffective or poorly tolerated, or those whose IGF-1 levels are extremely high.
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Dopamine Agonists
Patients also may be prescribed drugs called dopamine agonists. These agents work on dopamine receptors to inhibit GH release from the tumor.
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Radiotherapy
Radiotherapy involves the use of radiation to kill rapidly growing tumor cells. After radiation, tumors typically stop growing and may even begin to shrink; however, elevated hormone levels fall much more slowly. Medical therapy with a somatostatin analogue is often needed to normalize hormone levels and control symptoms before radiation starts to work.
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Controlling the 4 Goals of Acromegaly Treatment
Regardless of which treatment you and your doctor decide on at this time, you should be aware of which of the 4 goals of acromegaly treatment your therapy controls.
