Acromegaly

Therapy

Chris2na Chai - 2011

Acromegaly Therapy
Goals: - To decrease Insulin-like Growth Factor 1 (IGF-1) - To decrease Growth Hormone (GH) levels <1 ng/mL

Transphenoidal Surgery

Transphenoidal Surgery
Primary treatment of choice for pa2ents with pituitary adenoma Advantages: -95% and 70% adenoma shrinkage in pa2ents with microadenoma and macroadenoma, respec2vely -GH Secre2on falls in 80-90 % of pa2ents, typically within rst two hours -Preserva2on of secre2on of other hormones post surgery -Poten2al cure in pa2ents with microadenoma and rapid size reduc2on in pa2ents with macroadenoma -Mortality rate is less than 1% Disadvantages: -Recurrence (5-10%) or regrowth in pa2ents with microadenoma and macroadenoma, respec2vely -15% of pa2ents experience hypopituitarism -2% of pa2ents experience central diabetes insipidus

Medical Treatment
Typically used when surgery alone does not decrease IGF-1 levels or GH levels to an acceptable amount. Otherwise, when a pa2ent refuses surgery or would not achieve any benet from having the surgery. Types: -Somatosta'n Analogs: Octreo'de, Lanreo'de GH-inhibitory hormone analog Longer half-life than na2ve somatosta2n No Hypopituitarism Normal IGF-1 levels in 50% of pa2ents Adenoma shrinkage in 50% of pa2ents Injec2on (once a day/month) -Dopamine Agonists: Cabergoline Inhibit GH secre2on Oral Administra2on Normal IGF-1 levels in 40% of pa2ents No Adenoma shrinkage expected Associates with valvular heart disease -GH Receptor Antagonist Pegvisomant Compe22ve inhibitor of GH Receptors Normal IGF-1 levels in 95% of pa2ents No adenoma shrinkage Daily injec2on Associated with liver disease

Radiotherapy
Conven2onal
Alterna2ve therapy for pa2ents who are not responsive to surgical or medical treatment. 45-50 Gy radia2on dose over 5 weeks from MRI directed cobalt-60 or linear par2cle accelerator

Radiotherapy
Conven2onal
Alterna2ve therapy for pa2ents who are not responsive to surgical or medical treatment. 45-50 Gy radia2on dose over 5 weeks from MRI directed cobalt-60 or linear par2cle accelerator
Advantages -95% Adenoma Shrinkage Disadvantages -Normal IGF-1 levels in 50% of pa2ents a>er 10 years (SLOW) -Hypopituitarism in 50% of pa2ents a>er 10 years -Associated with neurologic decits

Conven2onal

Radiotherapy

Alterna2ve therapy for pa2ents who are not responsive to surgical or medical treatment. 45-50 Gy radia2on dose over 5 weeks from MRI directed cobalt-60 or linear par2cle accelerator
Advantages -95% Adenoma Shrinkage Disadvantages -Normal IGF-1 levels in 50% of pa2ents a>er 10 years (SLOW) -Hypopituitarism in 50% of pa2ents a>er 10 years -Associated with neurologic decits

Proton beam therapy Stereotac2c Surgery