Acromegaly may also be suspected if you or your healthcare provider notice amplified growth in your body or see abnormal bone growth, disproportionately enlarged organs, or a tumor on the pituitary gland via magnetic resonance imaging (MRI).
Once you’ve been diagnosed with acromegaly, additional tests may be ordered to see if the condition has affected other areas of your body. These tests may include an echocardiogram to check for heart issues, a colonoscopy to determine colon health, a sleep study to check for sleep apnea, and X-rays or a DEXA scan to monitor bone health.
Acromegaly Treatment
Most commonly caused by a noncancerous tumor of the pituitary gland (pituitary adenoma), acromegaly is often cured with surgery. Whether or not the entire tumor can be removed depends on its size and if it’s grown into nearby organ or tissue structures.
The goal of acromegaly treatment is to control tumor size, normalize GH and IGF-1 levels, improve symptoms, and prevent complications.
Neurosurgery
An operation by an experienced pituitary neurosurgeon is the first line of treatment and the only method for reaching a true cure for acromegaly. Your neurosurgeon will access the pituitary gland using the transsphenoidal approach, so named because the neurosurgeon uses the sphenoid sinus behind the nose for the procedure.
Using precise instruments, your neurosurgeon will enter the nasal cavity and create an opening in the sphenoid bone. Further openings will be made until a hole is created in the sella turcica, the bone that cradles and protects the pituitary gland.
Once the tumor appears in the operative field, your neurosurgeon will use high magnification to help distinguish the tumor from normal pituitary tissue. When the tumor has been removed, the tumor cavity is cleaned and sealed off. Barrow neurosurgeons do not make external incisions on the face and bruising is uncommon. In fact, most patients can return home the day after their surgery.
At Barrow Neurological Institute, our surgeons specialize in endoscopic pituitary surgery. Endoscopic pituitary surgery uses a tiny camera to enter the nostrils to remove the tumor. This method of surgery aims to minimize trauma to the tissue surrounding the pituitary gland while facilitating a speedy recovery with as little discomfort or pain as possible.
Endoscopic Transsphenoidal Pituitary Surgery Explained
Pharmacological Treatment and Hormone Therapy
Treatment with prescription medication is possible if surgery does not cause remission in your acromegaly or if surgery is not recommended due to other reasons specific. Medicines are also sometimes prescribed prior to surgery to improve the likelihood of a good outcome.
Octreotide or lanreotide are the two synthetic forms of the hormone somatostatin that stops GH release. These medications are often effective for the long-term control of acromegaly, but can only be administered by a large injection every four weeks. Due to the side effects of these drugs as well as their expense, surgery is generally preferred. Oral octreotide is a recently approved oral medication that can be used after being on injectable octreotide or lanreotide. This medication needs to be taken twice a day without food and has been shown to normalize IGF-1 levels just as effectively as injectable octreotide or lanreotide. Bromocriptine and cabergoline are from a class of drugs called dopamine agonists. They can lower IGF-1 and GH levels especially if the IGF-1 level is mildly elevated. Although not as effective as the synthetic hormones octreotide and lanreotide, they’re less expensive and more convenient to administer orally as opposed to an injection. They can be combined with octreotide in some people with no adverse long-term health effects. Pegvisomant is a drug that blocks the action of GH at the level of GH receptors in various parts of the body, thereby lowering IGF-1 levels. It must be administered daily by subcutaneous or beneath-the-skin injection. Pegvisomant is an option if you don’t respond to surgery or other medications.
Radiosurgery for Acromegaly
Gamma Knife radiosurgery is a highly advanced form of accurate radiation therapy that achieves results similar to those in the surgical techniques described above.
The ‘knife’ in this surgery is made up of many small beams of radiation focused on a very specific single point at the base of the skull where the pituitary gland resides. Each beam is too weak to damage healthy tissue, but at the point where the beams converge, they deliver a dose of radiation that’s lethal to the tumor.
Gamma Knife is an outpatient procedure, does not involve any incisions, and requires only brief sedation under general anesthetic. However, it can take several years for GH levels to return to normal using the Gamma Knife rather than the days or weeks with traditional surgery. As a result, Gamma Knife is often a last resort treatment for acromegaly after surgery and medications.