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Endocrine Disorders Acromegaly

Acromegaly: The Growth Disease

Summary & Participants

Being tall is a physical trait that's often valued in our society, whether it's on fashion runways or basketball courts. But for people with acromegaly, excessive growth is a symptom of a serious condition.

Medically Reviewed On: June 30, 2008

Webcast Transcript

ANNOUNCER: When acromegaly is suspected, blood tests are usually done to see if the patient has elevated growth hormone levels. These tests, however, may not catch all cases of acromegaly.

ANNE KLIBANSKI, MD: The blood tests are designed to diagnose acromegaly at a time when growth hormone secretion is abnormal, so that it's certainly possible, in very early stages of acromegaly, these tests may be normal. In fact, if there is a great clinical suspicion of acromegaly, and the blood tests that are done for screening purposes are normal, it's important to think about reevaluating these tests after six to twelve months, particularly if these symptoms continue.

ANNOUNCER: When a diagnosis is established, treatment should be started immediately to avoid further complications. Frequently, the first step is to surgically remove the pituitary tumor.

RENA SELLIN, MD: At the time of surgery, the goal in any pituitary tumor, or in any surgeries, to remove the tumor as completely as possible without damaging the normal tissues that are next to it. And that becomes one of the difficulties in that the pituitary, which is a very small and delicate area with a lot of other normal cells next to tumor cells, one tries to remove the tumor cells without damaging the normal tissues. That may not be possible.

ANNOUNCER: When surgery cannot remove the tumor completely, two classes of medications can be used to treat acromegaly-dopamine agonists, and somatostatin analogs.

ANNE KLIBANSKI, MD: The dopamine agonists, bromocriptine and cabergoline-also known as Parlodel and Dostinex-are orally administered, are relatively inexpensive, but they lack efficacy, so that even with cabergoline, the majority of patients cannot be controlled medically. These oral dopamine agonists also have significant side effects, primarily gastrointestinal, when used over time and at high doses.

The somatostatin analogs have the advantage of being more effective so that more than 60% of patients can normalize their hormone levels. They are given by injection, are expensive, and can also cause some, but typically mild, gastrointestinal side effects, including diarrhea and nausea. Overall, the somatostatin analogs have been far more effective than the dopamine agonists in the treatment of acromegaly.

ANNOUNCER: Therapies can stop the progression of acromegaly, and many symptoms go away after surgery or medication. But it's important to understand that treatment has its limits.

ANNE KLIBANSKI, MD: The types of signs and symptoms of acromegaly that are most responsive to normalization of hormone levels are that metabolic ones, such as glucose intolerance or high blood pressure. Also, the soft tissue changes-the changes in the hands, feet, and face-are often likely to respond to medical therapy or surgical cure.

ANNOUNCER: It's also important to realize that eliminating symptoms is not always the same as eliminating the disease.

ANNE KLIBANSKI, MD: Patients with acromegaly are sometimes treated such that their symptoms are better- that is, they feel less tired or weak, and have less sweating. Maybe their hands and feet will not be growing as much, but their hormone levels are not normalized. I think based on what we've learned, it is very critical to try as best as we can to normalize these hormone levels, to reverse the disease as best we can, and also help the patient with acromegaly achieve a normal lifespan.

ANNOUNCER: The only way to avoid permanent complications is to start treating acromegaly early. That's why it's so important to raise awareness of this disease.

RENA SELLIN, MD: If one thinks that their body is changing in the ring size, and the shoe size, or if you see an old friend who looks like Andre the Giant, who was an actor with acromegaly, don't just think to yourself. Tell him. And if they say, "It's none of your business," then, so be it. But if even one of them ends up going to their doctor and finding this problem early, then you've done a good deed for the day.

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