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.
Sheila’s story
Surgery
Surgery is often the first treatment option. The tumour can usually be removed through the nose under general anaesthesia, and most people go home after a short hospital stay. After surgery, hormone levels normalise, however approx. 50% of patients may still need medication if the tumour cannot be fully removed.
Medical treatment
Medications work in different ways. Some reduce hormone production, while others block its effects. These can be injections given at home every few weeks or in hospital, or daily tablets. Your doctor will guide you to the treatment that suits you best. The different medications are:
Somatostatin receptor ligands (SRL) are substances that resemble the natural hormone somatostatin, which is produced in the hypothalamus just above the pituitary gland. Somatostatin’s job is to inhibit the production of growth
hormone. SRLs are typically administered as long-acting depot injections, either by a healthcare professional, or by yourself at home. In some countries, the treatment is also available as a once-daily tablet.
Dopamine agonists are taken orally and work by suppressing the secretion of both growth hormone and prolactin from the pituitary gland. Their effect is generally modest compared to other available treatments, making them most suitable for patients with mildly elevated hormone levels or tumours that
co-secrete both prolactin and growth hormone. They may also be used in combination with other treatments if hormone levels remain inadequately controlled on other treatments alone. However, these treatments have not been approved by regulatory authorities for the treatment of acromegaly.
Growth hormone receptor antagonists
When growth hormone is released from the pituitary gland into the bloodstream, it triggers IGF-1 production in the liver. Growth hormone receptor antagonists block this effect, lowering IGF-1 production which regulates cell growth, bone development, and muscle mass without changing growth hormone levels. The medication is self-injected daily and suitable for patients that do not respond to surgery or SRLs. Starting dose should be administered by a healthcare professional.
Radiotherapy
Radiotherapy is reserved generally for third line treatment of patients with persistent disease or tumour growth despite surgery and medication, or for patients who are not suitable candidates for surgery.
Long-term follow-up
Acromegaly usually requires long-term follow-up. Even after treatment, regular check-ups and blood tests are important to monitor hormone levels and manage any ongoing symptoms or complications.
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.