How is acromegaly treated?
The main goal of acromegaly treatment is to reduce the level of a hormone called insulin-like growth factor-1 (IGF-1) to normal. This is called achieving ‘biochemical control’. Achieving biochemical control is important for alleviating symptoms and enhancing quality of life, as well as restoring life expectancy to normal.1-3
There are different ways of achieving biochemical control, as outlined below. Doctors recognise the importance of tailoring treatment to individual needs and preferences, so be sure to always share your views when discussing treatment options.
Surgery
Transsphenoidal surgery is the main treatment option for most people with acromegaly.3 This involves accessing the pituitary gland via a small cut inside the nose, enabling the tumour causing acromegaly to be removed.
Medical treatment
Some people are unsuitable for surgery, or they may not want it. In these cases, medicines are used to lower IGF-1. Medicines may also be used if surgery is unable to completely remove the tumour.
Somatostatin receptor ligands
Somatostatin is a hormone naturally made by the body, which inhibits the release of several other hormones, including growth hormone (GH). Somatostatin receptor ligands (SRLs) are man-made versions of natural somatostatin that mimic its actions and are used to treat acromegaly. SRLs are also known as somatostatin analogues (SSAs).
SRLs are used to treat acromegaly because the body breaks down SRLs more slowly than natural somatostatin, so the therapeutic effects of SRLs last longer. These medicines usually given by injection, up to 4 weeks apart in their long-lasting forms. You may hear SRLs called first-line medical treatment, because these are usually the first medicines prescribed for acromegaly.3
Other medicines
If SRL treatment isn’t producing desired results, a different type of medicine may be used, which blocks the action of growth hormone in the liver so that biochemical control can be achieved.3 Medicines of this type are called growth hormone receptor antagonists.3
There are also medicines called dopamine agonists which reduce growth hormone secretion. These are sometimes used to treat acromegaly, particularly in mild cases or in combination with other medicines.3 However, these treatments have not been approved by regulatory authorities, for the treatment of acromegaly.
Radiotherapy
Radiotherapy uses high-intensity radiation to destroy the abnormal cells that make up a pituitary tumour, with the aim of reducing growth hormone production. Radiotherapy is generally used when surgery and/or medical treatment have not been fully effective.3
References
1. Giustina A, et al. Pituitary 2024;27:7–22.
2. Katznelson L, et al. J Clin Endocrinol Metab 2014;99:3933–51.
3. Giustina A, et al. Rev Endocr Metab Disord 2020;21:667–78.