Acromegaly – Diagnosis and Treatment

Diagnosis

Healthcare providers often begin identifying acromegaly by reviewing the person’s symptoms and performing a physical exam.

If features like enlarged hands or facial changes suggest possible growth hormone excess, the provider usually orders lab testing.

Key Blood Tests:

Test Name	Purpose
Serum IGF-1 Level	Checks for too much IGF-1, which points to high growth hormone
Growth Hormone Suppression	Measures growth hormone after drinking glucose

A higher-than-normal IGF-1 reading indicates that the growth hormone level is too high. In a growth hormone suppression test, drinking a sugary drink should lower growth hormone. If the number stays high, acromegaly may be present.

Imaging Tools:

• Magnetic Resonance Imaging (MRI): Shows the size and spot of a pituitary adenoma or other tumors in the pituitary gland.
• Computed Tomography (CT): Providers use this if MRI is not an option.
• X-rays: Reveal changes in the bones of the hands and feet.

These steps help doctors confirm acromegaly and find pituitary tumors causing the overproduction of growth hormone.

Treatment

Removing the Tumor or Using Other Procedures

Doctors usually recommend removing the tumor that causes acromegaly. Surgeons most often target a tumor in the pituitary gland.

They commonly operate through the nose using a technique called transsphenoidal surgery, guiding special tools through the nasal passages to reach the pituitary gland and take out the tumor.

• When surgery works well:
  • Most helpful for small tumors.
  • Can lower growth hormone (GH) and insulin-like growth factor 1 (IGF-1).
  • Reduces pressure on nearby tissue, which may ease headaches and vision problems.

Some tumors are hard to reach or remove in full. If the whole tumor cannot be taken out, GH and IGF-1 can remain high. In these cases, doctors may recommend a second surgery, medicines, or radiation treatment.

Doctors consider other factors when planning surgery, such as tumor location, size, and the person’s overall health. For tumors outside the pituitary, surgeons use other methods.

Here is a summary of key details about surgery options:

Surgery Type	How It Works	Benefits	Possible Need for Further Treatment
Transsphenoidal (through nose)	Removes pituitary tumor via nose	Fast symptom relief; often first choice	Needed if tumor not fully removed
Other surgeries	For tumors outside pituitary	Can remove non-pituitary tumors	May need follow-up with medications or radiation

After surgery, providers monitor hormone levels with regular follow-up visits.

Drug Treatments

Doctors may recommend medicines when surgery does not return hormone levels to normal or if a person cannot have surgery. Some patients use these drugs alone; others use them with surgery or radiation.

Main types of medicine:

• Somatostatin Receptor Ligands (SRLs): These medications lower how much growth hormone (GH) the body makes. Synthetic forms of somatostatin signal the pituitary gland to reduce GH production. These are usually given as monthly injections, though some forms are taken by mouth. SRLs may also help shrink pituitary tumors.
• Dopamine Agonists: This class of medication can lower both GH and insulin-like growth factor 1 (IGF-1) in some individuals. These medicines are typically taken by mouth and may help reduce tumor size, though they are generally less effective than somatostatin-based therapies. Potential side effects include nausea, tiredness, nasal congestion, dizziness, mood changes, or sleep disturbances.
• Growth Hormone Receptor Antagonists: These drugs block GH from acting on body tissues. While they do not shrink the tumor or reduce GH levels in the blood, they block the hormone’s effects and help reduce IGF-1 levels. This therapy is usually administered as a daily injection. Regular liver function monitoring is required during treatment to ensure safety.

Overview of common medicine types:

Medicine Type	How Taken	Main Effect	Special Notes
Somatostatin analogues	Injection or oral	Lower GH & IGF-1, shrink tumors	Often monthly injections
Dopamine agonists	Oral	Lower GH & IGF-1, shrink tumors	May have more side effects
GH receptor antagonist	Injection	Lower IGF-1 only	Monitor liver function

Radiation and Other Ongoing Therapies

Providers consider radiation therapy if surgery or medicines cannot fully treat the tumor. Radiation targets the tumor cells with beams of energy, destroying them over time. The effects of radiation develop slowly, often over months or even years.

Types of radiation therapy include:

Radiation Type	Technology Used	Treatment Time	Key Points
Stereotactic radiosurgery	3D imaging	One time	Precise, less impact on healthy tissue
Proton beam therapy	Proton particles	Varies	Targets tumor, lower side effects
Conventional radiation	Regular X-ray	Multiple weeks	Higher risk to pituitary gland

• Stereotactic Radiosurgery: This type uses 3D imaging to deliver a high dose of targeted radiation. Usually, only one session is needed. Stereotactic radiosurgery can help bring GH levels down to normal within 5-10 years and limits damage to healthy areas near the tumor.

• Proton Beam Therapy: Proton beam therapy uses protons to target the tumor more accurately and may limit harm to the pituitary gland and nearby tissues compared to regular radiation.

• Traditional or Conventional Radiation: Providers deliver low doses of radiation over several weeks, usually 4-6 weeks. This type has a higher risk of damaging the pituitary gland. Its effects may not be clear for several years after treatment.

Providers schedule regular checkups for hormone testing after radiation. Radiation often affects other pituitary hormones, not just GH. Some people may need hormone replacement therapy if their other hormone levels drop.

Doctors often use a combination of surgery, medicines, and radiation.

All people who have treatment for acromegaly need regular appointments to check if their hormones are at safe levels. Providers use blood tests and imaging tests during these checkups.

Getting Ready for Your Medical Visit

Steps You Can Take Beforehand

Preparing for a visit with a healthcare professional helps make the most of the appointment.

• Ask about any special instructions. When making the appointment, ask if you need to follow any restrictions, like fasting before a blood test.
• Write down all symptoms. Note everything you have noticed, including headaches, changes in vision, increased sweating, changes in hand or shoe size, joint pain, tiredness, or trouble sleeping. Include symptoms such as high blood pressure, arthritis, sleep apnea, diabetes, menstrual changes, or sexual health problems.
• Make a list of your medicines and supplements. Include anything you take regularly, including vitamins and over-the-counter items.
• Track important personal changes. Write down anything new or different about your health: weight gain, fatigue, vision problems, changes in appearance, menstrual irregularities, erectile dysfunction, or mood changes.
• Bring old photographs. Photos from the past 10 years can help your healthcare provider notice changes in your jaw, hands, or facial features, which may be important in conditions like prognathism or enlarged hands.
• Ask someone to come with you. A family member or friend can help remember details or ask questions.
• List your questions. Preparing questions ahead of time can help you cover everything important. You might ask about causes of your symptoms, possible tests for diabetes mellitus or hypopituitarism, treatment options, expected outcomes, or risk of complications like joint disease and cardiovascular problems.

Sample Questions Table:

Question Topic	Example
Causes	What might be causing my symptoms?
Testing	What tests may be needed?
Treatment	What treatments are available?
Outcomes	What long-term issues should I expect?
Personal Health	How will this affect my other conditions?
Resources	Are there trusted websites or guides for me?

Having everything written down helps make sure nothing is forgotten during the appointment.

Questions Your Healthcare Provider May Ask

Healthcare professionals will likely ask specific questions to better understand your condition. Being prepared for these helps the visit go smoothly.

• List of common questions:
  • What symptoms do you have, and when did they start?
  • Have you noticed changes in appearance (such as facial features, hands, or jaw)?
  • How have your features changed over time? Do you have old photos to compare?
  • Have you noticed vision changes, headaches, joint pain, or more sweating?
  • Do you have new problems with sleep, such as sleep apnea, or other health issues like diabetes or high blood pressure?
  • Have you experienced symptoms related to sexual health, such as erectile dysfunction or menstrual changes (like amenorrhea or irregular periods)?
  • Have your rings, shoes, or gloves become tighter?
  • Have you recently had any tests, such as colon cancer screenings?

Sometimes, your provider will ask about problems with movement, balance, or mood, or if you have noticed any trouble with your vision, like bitemporal hemianopsia.