Acromegaly Treatment in Humans
Acromegaly treatment is focused on reducing the severity of symptoms, regulating excess hormone levels, and restoring the function of the pituitary gland. Surgery, medication, and radiation therapy are 3 ways of treatment that are generally recommended:
Ordinary transfenoidal surgery is recommended to remove tumors from the pituitary that suppress the nerves and trigger excess GH production. This action is done through the nose or upper lip, using endoscopy and other surgical tools to remove the existing tumor. This action is done under local anesthetic conditions.
Suggestions for taking medication and doing therapy may be done before or after surgery.
The following medications may be used for the treatment of support after surgery, or if surgery can not be performed (eg in the case of large tumors):
a. Dopamine agonist. Drugs such as bromocriptine and cabergoline serve to suppress the production of growth hormone. Both drugs are taken once or twice a week in pill form.
b. Analog somatostatin. Drugs such as lanreotide and octreotide are used to control the production and flow of growth hormones, as well as shrink the size of adenoma tumors. This drug is given in the form of injection in hospital, with initial dose 3 times a day to see its effectiveness, and continued once a month for a specified time period. These injections are generally given under the skin (subcutaneously) and in the butt muscles (gluteus muscle).
c. The antagonist of growth hormone. One example of this drug is pegvisomant. This drug serves to block the effects of growth hormone on body tissues, suppress symptoms, and regulate levels of IGF-I in the liver. Growth hormone antagonist drugs are usually given if the patient does not respond to other treatments, through daily subcutaneous injections at the hospital. This drug can not shrink the size of the tumor or reduce hormone levels in the body.
Radiotherapy is generally recommended if the patient does not respond well to surgery or medication. This therapy serves to destroy tumor cells that can not be reached before and slowly down the growth hormone levels.
Radiotherapy can be done in 3 ways:
a. Conventional radiation therapy. The tumor is targeted using an external beam (EBT) given in small doses with a gap of 4 to 6 weeks. This is done to avoid damage to the pituitary gland and brain tissue, as well as to give time for healing radiated tissue. The results of this therapy are generally felt after many years.
b. Gamma knife therapy (gamma knife). The tumor is targeted directly using a strong radiation beam, regardless of surrounding brain tissue. Patients will be asked to use a special head cover to minimize head movement. This therapy is only done once, with results that can be felt after 3 to 5 years. Gamma knife therapy also poses a risk of smaller side effects than conventional radiation therapy.
c. Proton radiation therapy. Not much different from gamma blade therapy, proton radiation therapy emits strong radiation on tumors with minimal effects on brain tissue. This therapy is given regularly, with a shorter intensity than conventional radiation therapy.
Doctors will usually recommend therapy according to the size and location of the tumor, as well as the levels of GH and IGF-I in the patient’s body. Follow the doctor’s advice and make sure that the patient or family is aware of advanced treatment steps, potential side effects, and complications that may occur during or after therapy.