Treatment of Acromegaly

Doctors treat acromegaly caused by benign tumors of the pituitary gland with surgery, medications and radiation. Your initial care arrange can rely upon your age, the scale and placement of your tumor, and different medical conditions you will have. Over time, you will would like over one kind of treatment. The goal of therapy is to come back your growth hormone and IGF-1 levels as near traditional as potential to avoid serious complications and eliminate the chance of premature death. With successful treatment, swelling and enlargement of your soft tissues could gradually subside. Treatment cannot reverse excess bone growth, however it will stop a lot of growth from occurring.

If your acromegaly is caused by a tumor outside your pituitary gland, your doctor can develop an individualized treatment arrange based mostly on the tumor's location and whether or not it's benign or cancerous.

 

Surgery
Doctors will take away several pituitary tumors using transsphenoidal surgery. during this procedure, named for the sphenoid sinus — air pocket behind the nose — your surgeon extracts your tumor through atiny low incision through the rear wall of your nose.

Because transsphenoidal surgery is advanced, it is important to decide on a surgeon experienced in performing this procedure. analysis has shown that a lot of-experienced surgeons who perform bigger numbers of procedures usually have more successful outcomes.

Removing the tumor surgically will quickly and effectively come back growth hormone levels to traditional and relieve pressure on the tissues around your pituitary gland. however even the foremost experienced surgeon might not be able to fully take away tumors that have grown giant or extended into nearby blood vessels or different structures. Incomplete tumor removal could end in growth hormone levels that keep high once surgery, requiring additional treatment with medication or radiation.

 

Medications
Doctors could value more highly to manage your acromegaly with medication if your pituitary tumor is inaccessible to surgery, or you are at high risk of surgical complications. you will conjointly would like medicine if your growth hormone levels keep high following surgery. Your would like for medications could continue for the remainder of your life. medicine used to lower the assembly of growth hormone or block its action heading in the right direction tissues include:

• Somatostatin analogues (SSAs). The medicine octreotide (Sandostatin, Sandostatin LAR) and lanreotide (Somatuline Depot) are artificial versions of the brain hormone somatostatin — growth hormone release-inhibiting hormone. they will decrease growth hormone levels by blocking the pituitary gland's excess production. they will conjointly shrink tumors over time. When beginning octreotide treatment, you initially inject yourself with a short-acting preparation underneath your skin (subcutaneously) each eight hours to work out if you have got any aspect effects from the medication and if it's effective. Then, if it's tolerated and effective, you'll take a long-acting kind that needs an injection into the muscles of your buttocks (gluteal muscles) by a health care skilled, administered once a month. Lanreotide is given as a long-acting subcutaneous injection once a month. Your health care skilled could offer the injection or teach you or a loved one the way to do it. Common aspect effects of SSAs embody pain at the injection web site, intestinal cramping and diarrhea, and gallbladder issues. 
• Growth hormone receptor antagonists (GHRAs). The medication pegvisomant (Somavert) blocks the result of growth hormone on body tissues. You administer pegvisomant yourself daily by subcutaneous injection. This medication will normalize IGF-I levels and relieve symptoms in the majority with acromegaly, however does not lower growth hormone levels or cut back the tumor size. Common aspect effects embody headache, fatigue, nausea and diarrhea.
• Dopamine agonists. Cabergoline (Dostinex) and bromocriptine (Parlodel) supply another strategy to scale back growth hormone production and shrink tumors. each medicine is taken as pills, however are effective for considerably fewer folks than are somatostatin analogues or growth hormone receptor antagonists. Doctors typically prescribe treatment combining dopamine agonists with somatostatin analogues. Common aspect effects of dopamine agonists embody nausea, intestinal cramps and headache.

 

Radiation
Your doctor could suggest radiation treatment if tumor cells stay once surgery and medicine is ineffective in reducing your growth hormone levels. Radiation therapy will quickly stop lingering tumor cells from growing and slowly cut back growth hormone levels. it should take years for this treatment to noticeably improve acromegaly symptoms, and you will still would like medication whereas you and your doctor look forward to your growth hormone levels to fall.

 

You receive radiation treatment in one in all 2 ways:

• Standard radiation therapy. this sort of radiation is sometimes given each weekday over four to 6 weeks. it should take 5 to ten years or a lot of for your growth hormone levels to come back to traditional.
• Stereotactic radiosurgery. Radiation may be given stereotactically, with exactly targeted, intense beams aimed toward a tumor from multiple directions. This strategy will deliver a high dose of radiation to tumor cells whereas limiting the number of radiation to nearby traditional tissues.

     Current stereotactic technologies deliver radiation with a gamma knife, a linear accelerator or a proton beam. These treatments is also given in an exceedingly single session or multiple sessions. rising proof suggests that stereotactic approaches could bring growth hormone levels back to traditional inside 3 to 5 years.
      Stereotactic radiosurgery is offered at a restricted range of U.S. medical centers. Pituitary tumors that are too near the purpose where the attention (optic) nerves cross don't seem to be eligible for stereotactic surgery. Your doctor can confirm which kind of radiation therapy is correct for you.

 

After your treatment for acromegaly, you will need monitoring by your doctor to form positive that your pituitary gland is functioning properly which your symptoms are becoming higher. This follow-up care could last the remainder of your life. as a result of acromegaly is linked to a risk of precancerous colon polyps, you must have a screening colonoscopy near the time of your diagnosis and at counseled intervals afterwards.