What is the treatment of Acromegaly ?
Acromegaly treatment is either through medicines, radiotherapy or through surgery of the brain.
Acromegaly, the endocrine disease caused by the excessive secretion of the growth hormone requires timely treatment to avoid the complications arising from this syndrome.
The following are the different options for the treatment of Acromegaly :
Medical treatment of Acromegaly :
1. Bromocryptine (Parlodel 2.5 and 10 mg tablets).
Bromocriptine is a dopamine agonist which paradoxically inhibits the growth hormone secretion in acromegalics. It is started in a dose of 2.5 mg daily (at night) and gradually increased to 30-60 mg/day. It has been claimed to improve both the skeletal and soft tissue manifestations.
The known side-effects are nausea, vomiting, constipation, dyskinesia, digital spasm and postural hypotension.
2.Pergolide mesylate may be useful and effective alternative to Bromocryptine.
- External gamma radiation: (Total 4500 rads). This has been shown to cause an improvement. The full effects may not be seen for 2-3 years.
- Accelerated proton beam: This permits a greater dose of radiation to be focused on the pituitary with less damage to the neighboring tissues. Doses up to 10,000 rads can be given. The disadvantage is a greater risk of cranial nerve and hypothalamic damage.
- Local implantation of radioactive isotopes of Yttrium, gold or strontium into the pituitary allows a greater does without producing hypopituitarism.
Ablation of the pituitary adenoma can be done by 3 methods:
- Classical transphenoid approach is still the therapy of choice in our set up. Transfrontal approach may be required for suprasellar extension or very large intracranial lesions.
- Stereotaxic placement of probes.
The complications of surgery are CSF rhinorrhoea, meningitis, third nerve palsy, diabetes insipidus, edema or hemorrhage into the pituitary and hypopituitarism.