Acromegaly is a hormonal disorder characterised by abnormal bone growth, enlarged hands and feet, and thickened, enlarged face.1 Learn more about this rare endocrine disease, its diagnosis and the different treatment options available.
Treatment focuses on two objectives:
- Removing the tumour and alleviating the symptoms,
- Normalising growth hormone production and halting the disease progression
There are two types of treatment available:
Surgery is the most common option to remove the pituitary tumour. The operation is often carried out using an incision through the nose. Removing the tumour promptly relieves the pressure on the surrounding structures and leads to a rapid lowering of growth hormone levels.1 The operation is successful, with no further treatment needed, in around nine out of ten cases with smaller tumours. The operation is less successful in those with larger tumours.2
When surgery is not an option, or if surgery does not successfully normalize the levels of IGF1 or growth hormone, of if the patient relapses, there are other potential treatments include radiotherapy or medication.
Medications are used to lower production of growth hormone and/or IGF1 by the tumour. The drug families in the treatment of acromegaly are :
- Somatostatin analogues, such as lanreotide or octreotide. These are man-made forms of the natural hormone, somatostatin. Somatostatin prevents growth hormone from being released from pituitary cells when the level of growth hormone in the blood is high. Somatostatin analogues reduce the level of growth hormone to normal in over half of cases and reduce the size of the tumour in about eight in ten cases. The main side effects of these drugs are gastrointestinal problems, such as abdominal pain, diarrhoea, or the presence of excess fat in the faeces (steatorrhoea).2,5,6
- Pasireotide is another somatostatin analogue that has been approved in the treatment of acromegaly, for whom surgery is not an option or has not been curative and who are inadequately controlled on treatment with another somatostatin analogue. The main side effect of pasireotide is that it can cause hyperglycemia and sometimes diabetes mellitus.2,7
- Dopamine agonists (such as cabergoline, bromocriptine and quinagolide) can be taken as tablets. They work by preventing the release of growth hormone from tumour cells. Side-effects such as feeling sick and dizzy are also quite common.2
- Pegvisomant does not act directly on the pituitary gland. It acts to block the effect of growth hormone on its receptor. It is administered daily by subcutaneous injection.2
Patients may consult with a number of different specialists, depending on the symptoms and the progress of the disease such cardiologists, ophthalmologists, rheumatologists.
2 to 42
New cases of acromegaly per year per million population.
Average age of diagnosis2
1 Acromegaly – NHS Choices [Internet]. Nhs.uk. [cited 18 January 2017]. Available from: http://www.nhs.uk/conditions/acromegaly/Pages/Introduction.aspx Last accessed 18/07/2017
2 Acromegaly. Growth Hormone disorders Information; Symptoms | Patient [Internet]. Patient. [cited 18 January 2017]. Available from: http://patient.info/health/acromegaly-leaflet Last accessed 18/07/2017
3 What is Acromegaly? [Internet]. Acromegaly.org. [cited 18 January 2017]. Available from: https://acromegaly.org/en/23-what-is-acromegaly. Last accessed 18/07/2017.
4 Symptoms and causes – Acromegaly – Mayo Clinic [Internet]. Mayoclinic.org. [cited 18 January 2017]. Available from: http://www.mayoclinic.org/diseases-conditions/acromegaly/symptoms-causes/dxc-20177626 Last accessed 18/07/2017