Treatment for patients with acromegaly includes surgical, radiation, and medical therapies.[1] Treatment will depend on the size and extent of the tumor and the need for rapid cessation of hormone function that results in serious clinical sequelae (i.e., hypertension and cardiomyopathy). Microadenomectomy or macroadenoma decompression is approached transsphenoidally in most patients. Increasingly, endoscopic surgery is used to allow the entire surgical field to be viewed and to allow tumor tissue that would otherwise be inaccessible with rigid instruments to be safely resected. Complete return of growth hormone (GH) concentrations to normal, however, is not often achieved. Increasingly, adjunctive radiation therapy is reserved for tumors that extend beyond the safe operative area and appear to pose an ongoing threat. Drug treatment, whether used as an adjuvant or primary therapy in appropriately selected patients, which is advocated by some,[2] includes the use of somatostatin analogues, such as octreotide; dopamine analogues, such as bromocriptine; and, the GH-receptor antagonist, pegvisomant. As the first of a new class of GH-receptor antagonists, pegvisomant works by inhibiting functional dimerization of GH receptors and thereby inhibits GH action. Preliminary results indicate that it may be the most effective medical treatment for acromegaly reported to date.[3,4] In acromegalic patients, impaired glucose tolerance, hypertension, and hyperlipidemia should be vigorously treated concurrently with definitive therapy. A multidisciplinary clinical approach may be required for the treatment of arthritis, carpal tunnel syndrome, obstructive sleep apnea, and prognathism.[5]

STANDARD TREATMENT OPTIONS: [1,3,4]

1. Surgery (usually a transsphenoidal approach).
2. Bromocriptine.
3. Somatostatin analogues, such as octreotide.
4. The GH-receptor antagonist, pegvisomant.
5. Surgery and postoperative radiation therapy.

References:

1. Levy A: Pituitary disease: presentation, diagnosis, and management. J Neurol Neurosurg Psychiatry 75 (Suppl 3): iii47-52, 2004.
2. Kleinberg DL: Primary therapy for acromegaly with somatostatin analogs and a discussion of novel peptide analogs. Rev Endocr Metab Disord 6 (1): 29-37, 2005.
3. Stewart PM: Pegvisomant: an advance in clinical efficacy in acromegaly. Eur J Endocrinol 148 (Suppl 2): S27-32, 2003.
4. Muller AF, Kopchick JJ, Flyvbjerg A, et al.: Clinical review 166: Growth hormone receptor antagonists. J Clin Endocrinol Metab 89 (4): 1503-11, 2004.
5. Colao A, Ferone D, Marzullo P, et al.: Systemic complications of acromegaly: epidemiology, pathogenesis, and management. Endocr Rev 25 (1): 102-52, 2004.