Medications for acromegaly do not always reverse the growth or reduce the tumor. Monitoring for life is usually what is required to give the growth hormone under control.
Acromegaly is a condition where the pituitary gland releases too much growth hormone and the effects on the sufferers of this disease can be fatal.
The first step to diagnosing acromegaly is to see your doctor who will conduct a physical examination.
IGF-1 blood levels measure a hormone that is secreted in the liver. This hormone is high when someone has acromegaly.
Measuring the growth hormone
Measuring this hormone is done before and after ingesting glucose. Normally growth hormone levels fall after taking the glucose. It the level remains the same the person is suffering from acromegaly.
Once the growth hormone levels have been found to be consistent with acromegaly the doctor will order an MRI to locate the tumor and determine its size within your brain.
A CT scan may be ordered to locate the tumor.
If no tumor is found, more blood tests and more imaging tests will be done on the chest and abdomin to see if the tumor may be located there.
Treatment for acromegaly
The treatment will depend upon your age and general health. Treatments cannot reduce bone growth but can prevent future bone growth. Some body features may even be restored.
Surgery is usually the first course of action
This surgery is done to excise the tumor through the back of your nose from an area called the sphenoid sinus.
This procedure is very complicated and you must choose a well qualified surgeon who has lots of experience performing these operations.
If the operation is a complete success the growth hormone levels will go back to normal. However, if the tumor could not be entirely removed because it was too big or had extended into blood vessels then the growth hormone levels will not return to normal levels and radiation may be required.
Medications are used when the tumor cannot be removed, you are at a high risk for surgery, or you had surgery and the tumor was not completely removed.
Somatostatin analogues (SSAs)
The drugs are the synthetic version of the “brain hormone somatostatin — growth hormone release-inhibiting hormone. The drugs block the excess production of the growth hormone. The drug is administered by once a month injections into the buttocks.
The injections of Lanreotide is done by a health care professional but sometimes family members may be shown how to do it at home.
side effects of SSAs include:
- pain at the injection site
- intestinal cramping and diarrhea
- gallbladder problems.
Growth hormone receptor antagonists (GHRAs)
Pegvisomant (Somavert) will block the damage of growth hormone on body tissues. The drug will relieve the symptoms but cannot lower the levels of growth hormone in the body. Neither can it reduce the size of the tumor present.
These drugs can be taken in pill form and reduce the growth hormone production and help shrink the tumor. The drugs are less effective than the other drugs for treating the symptoms and may be combined with the other drugs for that reason.
Doctors often opt for radiation treatment to restore the growth hormone levels to normal and to eradicate any lingering tumor cells. It may take years before progress is visible with radiation treatments.
The radiation treatment can be the standard treatment or it can be a treatment called Stereotactic radiosurgery.
Stereotactic radiosurgery targets the tumor cells and does not invade surrounding tissue. Since the radiation is beamed from several directions, the patients receives a higher dose of radiation than would be given with the standard method.
The procedure is done with what is called a gamma knife. The growth hormone produced in the body can return to normal within three to five years, which is less than half the time required if standard radiation is used.
Caution: Stereotactic radiosurgery is a risky procedure since the tumor is so close to the eyes (optic nerves) and it is only offered in a few medical centers in the USA.
There will be follow up testing for acromegaly which will probably continue all your life. The doctor will also advise colon screening because this disease often produces pre-cancerous polyps.