Acromegaly is a disease characterized by an increase in certain organs

Acromegaly is a disease characterized by an increase in certain organs and parts of the body. Patients often complain of impaired vision, headaches, pain in joints, and high blood glucose. If this disease begins in adolescence – then it is called gigantism – which in turn is characterized by a high height of the patient (over 2 m) with low parents (and other relatives). Improperly treated gigantism evolves at an older age to acromegaly.

The cause of the disease is the hormone-active pituitary adenoma (somatotropinoma), which produces growth hormone (STH, somatotropic hormone), which leads to an increase in the insulin growth factor – 1 (IGF-1; Somatomedin C), which in turn causes the above changes.

Diagnosis of this disease requires an additional examination that includes an MRI of GM with iv contrast enhancement (area of the pituitary gland) and a blood test for the above hormones. Noticeable symptoms usually occur 5-10 years after the onset of the disease, depending on the amount of hormones produced by the pituitary adenoma. Unfortunately, the cause of the pituitary adenoma has not been completely determined.

If the above symptoms appear, such as an increasing size of hands and feet, the chin, nose, roughening of facial features, possible visual impairment, pain in joints, you can make an appointment with a neurosurgeon Dmitrii Sergeevich Teslenko, who specializes in treating pituitary adenomas, and based on the medical history, complaints, and general examination will recommend the necessary additional examinations.

Treatment

The main method of treatment of acromegaly and gigantism include neurosurgical treatment – surgical removal of the pituitary adenoma through transnasal approach. In case of any contraindications to the operation, radiation therapy (radiotherapy/radiosurgery) and/or drug therapy is carried out. The last two types of treatment, unfortunately, do not remove the tumor but only affect a decrease in blood hormones.

Risk factors for patients with acromegaly include the development of severe cardiovascular pathologies, severe forms of diabetes mellitus, impaired joint function, an high risk of malignant neoplasms of other organs and systems, etc.

Treatment of patients with such diagnosis is primarily aimed at removing pituitary adenoma, decompression of the optic nerves and lowering the level of growth hormone and IGF-1.

Adequate treatment ensures:

• Reduction of the external signs of the disease (reduced hands and feet due to cartilage tissue, reduced swelling of the face)
• Decrease in or ease from joint pain;
• Improvement of the internal signs of the disease (an improved state of the cardiovascular and endocrine systems);
• Total tumor resection will reduce the likelihood of relapse of the pituitary adenoma, normalize the blood level of hormones, which helps prevent the further development of the disease.

Surgery

Neurosurgery applies two main approaches:

• Transnasal (removal of the pituitary adenoma through the nose, without a skin incision and any cosmetic defects – the most popular approach)
• Transcranial (a scalp skin incision, trepanation; the method is used if the pituitary adenoma spreads far beyond the midline);

The neurosurgeon chooses the most optimal approach based on the MRI images and the spread of the tumor into important structures of the brain. The pituitary microadenoma is completely removed; macroadenomas and giant pituitary adenomas are removed as maximum as possible, depending on the density of the tumor and its bleeding. The operation helps promptly achieve the desired result, relieve headaches and compression of the optic nerves, and quickly reduce high blood hormones.

Radiation therapy (radiotherapy/radiosurgery)

Radiation therapy is rational if surgical intervention is contraindicated, or if the tumor location makes it impossible to remove it without severe disability of the patient.

There are radiotherapy and radiosurgery distinguished based on the type of exposure and the device suitable for patient exposure in each case.

Successful exposure may reduce the tumor size, due to a decrease in fluid in its structure. However, over time, the risk of relapse of the tumor and continued growth is very high.

Pharmacotherapy (drug therapy) 

Drug therapy is primarily aimed at decreasing the blood level of hormones (STH and IRF-1) rather than at reducing the size of the tumor. The cost of effective drugs is about 1000 US dollars per month, with life-long medication. The overall cost of treatment can be found out after the doctor’s recommendations.

Drug therapy can replace the pituitary adenoma surgical removal if the tumor is small (less than 1 cm, with minimal compression of the surrounding structures), and only if the patient tolerates the drug well, i.e. the medicine does not cause side effects.

Thus, the patient should be ready for the financial burden on average of 12,000 US dollars per year if choosing an effective drug therapy.

The treatment of the disease is strictly supervised by a professional doctor who sets the timing of drug administration and dosage.

Sometimes dopamine agonists (somatotropin) are prescribed to treat pituitary adenomas, but their effect on the tumor may be doubtful if it does not have receptors for these drugs. Therefore, the appointment of these drugs without a thorough examination of the tumor is unprofessional.

Before choosing the treatment strategy for the disease, a number of studies are carried out, all possible treatment options are considered and compared with possible contraindications regarding the individual characteristics of the patient.