Current Treatments for Acromega... Video Transcript

Participants

Ann Danoff MD, David Kleinberg MD, Shlomo Melmed MD, Michael Eckstein MD

Summary

Elevated levels of growth hormone affect the whole body. There is a wide range of treatment options for this condition, called acromegaly. Listen to experts describe therapies from surgery to medication.

Webcast Transcript

DAVID KLEINBERG, MD: Acromegaly is a disease of excess growth hormone. And the effects that excess growth hormone has usually comes from a pituitary tumor and accounts for overly 99% of the acromegalic cases. So the tumor can cause a problem or the excess growth hormone can cause a problem.

ANNOUNCER: The problems related to the tumor itself are called "mass effects." They occur when the tumor grows against structures in the brain.

ANN DANOFF, MD: The mass effect can result in symptomatic headaches and can also result in cranial nerve problems. There are a bunch of nerves that are very important for visual function that run right in the area of the pituitary. The optic chiasm, which supplies the nerve to the eyes, sits right, very close to the top of the pituitary gland. And if the pituitary gland enlarges, it can press on the optic chiasm and cause visual field problems.

ANNOUNCER: The hormonal effects stem from the increase in growth hormone, and include arthritis, trouble sleeping, tumors, heart problems and lung problems.

The hormonal effects also cause the growth and thickening of tissue, leading to the enlargement of internal organs, as well as noses, the brow, feet and hands. The growth of the tumors responsible for acromegaly is very slow, and so is the increase in levels of growth hormone. Often patients do not notice signs of change.

ANN DANOFF, MD: I remember the first patient I ever took care of with acromegaly, who just didn't realize that he had a problem. He was an auto mechanic and his kind of understanding about why his hands were getting bigger was because he was using his hands, working on cars all the time.

ANNOUNCER: When a doctor suspects acromegaly, diagnosis is usually quite simple. Blood tests detect elevated levels of growth hormone, and a related hormone called insulin-like growth factor 1, or IGF-1.

When discovered early, treatment with surgery can have a very good outcome.

ANN DANOFF, MD: For the lucky people who have small tumors there's a very good chance of having a surgical cure. So if you've got a small tumor causing acromegaly, something that's caught early, surgery would be a very reasonable first approach.

ANNOUNCER: When the tumor is large, or spread around blood vessels or the optic nerve, surgery is less likely to cure the disease. Doctors sometimes will try radiation therapy. But usually they move on to treatment with medicines. A drug that mimics a naturally-occurring hormone, somatostatin, is often very effective.

DAVID KLEINBERG, MD: Somatostatin normally controls growth hormone secretion. So it is produced in the body and it has a very important mechanism in the normal control of production of growth hormone.

ANN DANOFF, MD: In the situations where surgery is not a cure, somatostatin analogues play a key role in normalizing both growth hormone and IGF-1 levels.

ANNOUNCER: The somatostatin analogue available in the US is called Sandostatin. It is very effective in relieving the symptoms of acromegaly, and there is some evidence it also affects the growth of the tumor.

DAVID KLEINBERG, MD: Somatostatin analogues or Sandostatin can be effective in reducing tumor size. So either 30 or 50% of tumors will have some shrinkage. The others may not have shrinkage, but it's very rare to see growth of tumor when people are on this medication, so it is possible that there is prevention of further growth once you start treating the tumor when it's a certain size.

ANNOUNCER: Another drug useful in treating a acromegaly in a minority of patients are dopamine agonists. Like somatostatin analogues, they attach to receptors on tumor cells, and reduce the secretion of hormones.