Knowing Your Acromegaly Care is in the Right Hands

Superior Treatment for Patients with Acromegaly

As one of the most comprehensive pituitary disorder programs in the United States, the Pacific Pituitary Disorders Center at Pacific Neuroscience Institute (PNI) offers world-class expert care. Among the top ranked neurology and neurosurgery programs in the nation, our center’s compassionate multidisciplinary specialists provide advanced, personalized treatment while focusing on our patients’ quality of life.

Affiliated with award-winning Providence hospitals Saint John’s Health Center and Little Company of Mary, PNI neurosurgeons lead the way in advancing safer, more effective keyhole and minimally invasive endoscopic pituitary tumor removal approaches.

If you, a family member, or friend have a new diagnosis, require a second opinion, or have a pituitary tumor or related hormonal disorders recurrence, our expert physicians can help you understand your condition and determine an optimal treatment plan.

Think Pituitay. Think PNI.

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For information about pituitary disorder treatment please complete the form below. We will respond to you within 12-24 hours. To speak with someone right away contact us at 213-214-2526.

Symptoms

The most obvious symptoms of acromegaly and excess GH are external physical changes that often include:

  • Enlargement of the hands (increase in ring size) and feet (increased shoe size)
  • Frontal bossing (enlargement of the forehead) and prognathism (jaw enlargement)
  • Development of an underbite, spreading teeth, an enlarging tongue
  • Increased snoring and sleep apnea
  • Carpel tunnel syndrome
  • Excessive sweating

Additional serious problems may include:

  • Hypertension
  • Diabetes mellitus
  • An increased risk of colon cancer

With GH-secreting macroadenomas, there may be other symptoms like:

  • Visual loss
  • Headaches
  • Pituitary gland failure
  • Fatigue
  • Depression
  • Impotence
  • Loss of libido in men
  • Menstrual irregularities
  • Galactorrhea (milk discharge from the breast) in women
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Diagnosis

Comparing old and recent photographs will often demonstrate gradual but dramatic changes in facial appearance.

However, acromegaly is diagnosed by:

  • Growth Hormone Evaluation: Documenting elevated levels of both GH and IGF-1. An oral glucose tolerance test is often used to confirm excess GH production.
  • MRI Imaging: Following hormonal testing that confirms acromegaly, an MRI of the pituitary should be performed to confirm the presence of a pituitary adenoma.

For patients with visual complaints, formal visual field testing by an ophthalmologist or neuro-ophthalmologist should be performed.

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Treatment

Acromegaly Surgery

Surgical removal is considered first-line treatment for GH-secreting acromegaly.

Endoscopic Endonasal Surgery for Treatment of Acromegaly

Because of improved tumor visualization, the endoscopic endonasal approach is rapidly becoming the preferred method for removal of most pituitary adenomas, including GH-secreting adenomas.

Long-term remission of acromegaly is often not possible in patients with large or invasive macroadenomas. However, in such invasive tumors, removal of the great majority of the tumor can greatly improve problems associated with acromegaly (visual loss, pituitary gland dysfunction and headache) and typically improves hypertension, diabetes and soft tissue swelling.

Additionally, such maximal tumor debulking improves the chances of achieving remission with medical therapy using medications such as lanreotide or octreotide. After surgery, it typically takes at least 4-6 weeks for the IGF-1 level to reach its lowest level due to its very long metabolic half-life.

What medication is used to treat acromegaly?

For patients with persistent GH and IGF-1 elevations 3 months of more after surgery, octreotide or lanreotide treatments are generally indicated.

Octreotide (given three times a day by injection or by one monthly injection), or lanreotide (deep subcutaneous injections every 4 weeks) achieve long-term suppression of GH in about 70% of patients.

Lanreotide and octreotide also cause tumor shrinkage in 30-50% of patients, and improve soft tissue swelling, headache, joint pains and sleep apnea.

Preoperative use of octreotide and lanreotide may facilitate tumor removal and lessen risks of general anesthesia.

Side effects may include loose stools, malabsorption, cholelithiasis (gall stones), and local pain at the injection site. Pegvisomant, a GH receptor antagonist, is also effective in lowering IGF-1 levels although it does cause an elevation in GH levels.  

In patients who have GH-secreting adenomas that also co-secrete prolactin, the dopamine agonists cabergoline or bromocriptine can be combined to help normalize GH and prolactin levels and halt tumor growth.

Stereotactic Radiosurgery (SRS) or Stereotactic Radiotherapy (SRT) for Acromegaly

For patients with uncontrolled acromegaly after surgery and medical therapy, SRS (one dose) or SRT (multiple doses), can be used to deliver precise radiation directly to the tumor.

These techniques are effective in lowering GH and IGF-1 levels and stopping tumor growth in approximately 40-60% of patients. However, the lowering of GH and IGF-1 levels takes longer with SRT (average 7 years) compared to SRS (average 18 months). Pituitary gland failure can often occur in the years after SRS or SRT. Complications such as visual loss are rare with either SRS or SRT.

Patient Outcomes

Long-term remission is seen in 80-90% of patients with microadenomas and in 40-60% of patients with macroadenomas or invasive adenomas. In general, the higher the pre-operative GH level and the larger the tumor, the lower the chance for cure or long-term remission.

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