acromegaly
ACROMEGALY
Acromegaly is a chronic, slowly developing disease with progressive disfigurement and disability. An early diagnosis is difficult as most signs and symptoms are due to long-standing overproduction of growth hormone &/or insulin-like growth factor (IGF-I) causing metabolic, endocrine and morphological changes.
Surgical intervention is the first-line of treatment for almost all patients with acromegaly unless there are contraindications or the patient refuses to undergo the procedure.

Radiotherapy

  • Considered as an adjunctive treatment in patients not fully responding to surgical or pharmacological therapy
  • Should generally be reserved as third-line treatment in patients who have not achieved tumor growth control or normalization of hormone levels with surgery and/or medical therapy
  • May also be used in patients receiving GHRA (who have failed other medical therapies) and are at risk of tumor growth
  • Other endocrinologists have used radiotherapy in patients controlled on medical therapy to allow termination of such therapy (which is potentially lifelong)
  • Conventional radiotherapy can normalize insulin-like growth factor-I and lower growth hormone levels in >60% of patients
    • However, maximum response is achieved 10-15 years after administration of radiotherapy
    • Medical therapy with SSAs is usually required during this latency period
  • Choice of technique depends on tumor characteristics
    • Conventional radiotherapy is preferred for large tumor remnants or tumors that are near to optic pathways
    • Stereotactic radiotherapy is the choice for smaller tumor size or if convenience for patient is desired
  • Main limitations of radiation therapy is safety, with hypopituitarism observed in >50 % of patients
    • Advise patients that serial pituitary function follow-up is needed to evaluate for hypopituitarism
    • Follow-up includes assessment of thyroid, adrenal and gonadal functions at least annually
  • Conventional radiotherapy may carry risk of second tumors or cerebrovascular events due to radiation vasculopathy
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