
Treatment and Management of Acromegaly
Treatment Goals
Based on a consensus of over 60 of the top experts in acromegaly, there are 4 goals in the treatment of acromegaly1:
- Reduce concentration of GH and IGF-1 to a normal level
- Relieve pressure from the pituitary tumour on the optic nerves and surrounding areas of the brain
- Preserve normal pituitary function
- Reverse or improve the symptoms of acromegaly
Treatment Options
Recommendations by the Expert Consensus Guideline for acromegaly include:
Surgery to remove the tumour
Medical therapy
Sandostatin® LAR®
Efficacy
Dosing
Radiation therapy of the pituitary
Frequently, adequate control of acromegaly calls for a combination of 2 or more of the current options.

Figure adapted from Melmed et al.2
Mortality
Patients with acromegaly have a reduced life expectancy, with an increased mortality rate of 2- to 4-fold. The main determinant is the most recent serum GH concentration measured over a 24-hour period; increased mortality is also associated with elevated IGF-1. Analysis of acromegalic patients has shown that posttreatment GH levels in excess of 5 µg/L to 10 µg/L predict increased mortality.3,4
The duration of symptoms before diagnosis, older age at diagnosis, duration of disease, and the presence of diabetes, hypertension, and cardiovascular disease are other factors associated with increased mortality.2,5
A decrease in the level of GH to <2.5 µg/L improves mortality.2
References: 1. National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, US Department of Health and Human Services. Acromegaly. Bethesda, MD: National Institutes of Health; 2008. NIH publication 08-3924. 2. Melmed S, Colao A, Barkan A, et al. Guidelines for acromegaly management: an update. J Clin Endocrinol Metab. 2009;94:1509-1517. 3. Ben-Shlomo A, Melmed S. Acromegaly. Endocrinol Metab Clin North Am. 2001;30:565-583. 4. Bates AS, Van't Hoff W, Jones JM, Clayton RN. An audit of outcome of treatment in acromegaly. Q J Med. 1993;86:293-299. 5. Molitch ME. Clinical manifestations of acromegaly. Endocrinol Metab Clin North Am. 1992;21:597-614.



