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Endocrine System

Treatment involves lowering your production of GH, as well as reducing the negative effects of the tumor on the pituitary and surrounding tissues. Often, you'll need more than one type of treatment:

Surgery is commonly the first treatment option. Most pituitary tumors can be removed by a method called transsphenoidal surgery. While under general anesthesia, the surgeon works through your nose to extract the pituitary tumor. With smaller tumors, the procedure successfully eliminates the entire tumor and normalizes GH production in up to 90 percent of people. With larger tumors, there is a lower likelihood of removing the entire tumor, and many people may have elevated GH levels after surgery, requiring further medical or radiation treatments. Removing the tumor, even partially, can eliminate the pressure on the tissues surrounding your pituitary to relieve associated symptoms.

Drugs used to lower the production or block the action of GH include:

  • Octreotide (Sandostatin). This drug can interfere with the excessive secretion of GH by the pituitary, and thus can produce rapid declines in GH levels. When starting on octreotide, you initially inject yourself with a short-acting preparation under your skin (subcutaneously) three times a day to determine if you have any side effects from the medication and if it's effective. Then, you may be able to take a long-acting form that requires an injection into the muscles of your buttocks (gluteal muscles) by your doctor and administered once a month. Side effects of octreotide may include diarrhea, bloating, cramping and nausea.

  • Cabergoline (Dostinex) or bromocriptine (Parlodel). These medications, called dopamine agonists, are taken as pills, and in some people, they can lower levels of GH and IGF-I by reducing the size of pituitary tumors.

  • Pegvisomant (Somavert). This medication, a growth hormone antagonist, received Food and Drug Administration approval in April 2003. It acts to block the effect of GH on body tissues. You administer this medication yourself daily by injection.

Your doctor may recommend radiation treatment when tumor cells remain after surgery. Radiation therapy destroys any lingering tumor cells, and reduces GH levels. It is given in one of two ways:

  • Conventional "fractionated" radiation therapy. This type of radiation therapy is usually given daily over a period of 4 to 6 weeks.

  • Stereotactic radiosurgery. Also known as gamma knife radiation therapy, stereotactic radiosurgery can deliver a high dose of radiation to the tumor cells in a single dose while limiting the amount of radiation to the normal surrounding tissues.

The type of radiation therapy recommended depends on the size and location of the remaining tumor cells.

Even after initial treatment, acromegaly requires periodic monitoring by your doctor to make sure that your pituitary is functioning properly. This follow-up care may last for the rest of your life.


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