How treat?

Nature and target of treatment is contingent upon the clinical abnormalities that have resulted from excess growth hormone secretion. Although there are generally accepted approaches to the management of Acromegaly, the specifics vary considerably between physicians and patients.

There are four modalities of treatment for patients with Acromegaly. These may be used either singly, or in combination, in individual patients. At present, surgery is the first line of treatment for most patients with either micro and/or macroadenomas. Surgery may not be totally curative especially in patients with macroadenomas. In these patients, the surgery may be used to debulk the tumor mass and to prevent or reverse further local damage especially stretching of the optic nerves and invasion of the cavernous sinuses. Failure to normalize IGF-1 levels by surgical removal would then necessitate adjunctive medical/drug therapy and/or radiotherapy.

More recently, there is an increased interest in the use of medical therapy as a first line treatment option. This approach is considered more frequently in patients in whom total removal of the pituitary tumor is not anticipated, macroadenomas not impinging on the optic chiasm , as well as in those unfit for surgery (elderly, frail, high surgical or anesthetic risk, cardiovascular or pulmonary complications) or those who refuse surgery. Total surgical removal of microadenomas may be successful in as many as 80-90% of patients. However in less than ~50% of patients with macroadenomas is surgery curative.

continue