Acromegaly treatment options include surgical removal of the tumor that is causing acromegaly, drug therapy, and radiation therapy. Each one of these acromegaly treatment options can be successful in its own way. Your doctor can help you to determine which one is best for your specific situation. As with any medical procedure, treatment for acromegaly can have associated side effects and risks, which your doctor can also discuss with you.
Acromegaly Treatment: An Introduction
The goals of acromegaly treatment are to:
- Reduce growth hormone (GH) production to normal levels
- Relieve the pressure that the growing pituitary tumor exerts on the surrounding brain areas to preserve normal pituitary function
- Reverse or improve the acromegaly symptoms.
Currently, the treatment options for acromegaly include:
- Surgical removal of the tumor
- Drug therapy
- Radiation therapy of the pituitary.
Surgery is a rapid and effective treatment for acromegaly. The surgeon reaches the pituitary through an incision in the nose and, with special tools, removes the tumor tissue in a procedure called transsphenoidal surgery. This procedure promptly relieves the pressure on the surrounding brain regions and leads to a lowering of GH levels.
If the surgery is successful, facial appearance and soft tissue swelling improve within a few days. Surgery is most successful in patients with blood GH levels below 40 ng/mL (nanograms per milliliter) before the operation and with pituitary tumors no larger than 10 mm in diameter. The success of this acromegaly treatment also depends on the skill and experience of the surgeon. Furthermore, the success rate depends on what level of GH is defined as a cure. The best measure of surgical success is normalization of GH and insulin-like growth factor (IGF-1) levels. Ideally, GH should be less than 2 ng/mL after the patient is given a glucose test. A review of GH levels in 1,360 patients worldwide immediately after surgery revealed that 60% had random GH levels below 5 ng/ml.
Complications of surgery may include:
- Cerebrospinal fluid leaks
- Damage to the surrounding normal pituitary tissue, requiring lifelong pituitary hormone replacement therapy.
Even when surgery is successful and hormone levels return to normal, patients must be carefully monitored for years for a possible recurrence. More often, hormone levels improve but do not return completely to normal. These patients may then require additional acromegaly treatment, usually with medications.