Acromegaly is an uncommon hormonal disorder caused by the excess production of growth hormone (GH) after skeletal growth plates have closed. This overproduction, typically originating from a non-cancerous pituitary tumor (adenoma), causes characteristic physical changes and systemic health problems. Since the disease affects multiple organ systems and requires a complex, multi-modal approach, managing acromegaly demands a highly specialized and coordinated multidisciplinary team. Effective treatment focuses on reducing the tumor mass and normalizing levels of GH and its mediator, insulin-like growth factor-1 (IGF-1).
The Central Role of the Endocrinologist
The endocrinologist serves as the primary medical gatekeeper and long-term manager, overseeing the entire treatment plan. Diagnosis begins with biochemical testing, involving a blood draw to measure IGF-1 levels, which reflect average GH secretion. Confirmation often involves an oral glucose tolerance test (OGTT), where the failure of GH levels to suppress after consuming glucose indicates the presence of a hormone-secreting tumor.
Once the diagnosis is confirmed, the endocrinologist determines the optimal treatment sequence, often combining surgery, medication, and radiation. They manage medical therapy, which may be used before surgery to shrink the tumor, after incomplete surgical removal, or as a primary treatment. This management involves various classes of powerful drugs targeting different parts of the disease process.
The endocrinologist commonly prescribes somatostatin analogs (e.g., octreotide or lanreotide). These injectable medications bind to receptors on tumor cells to directly inhibit GH secretion. For some patients, dopamine agonists like cabergoline may suppress GH release, especially in tumors that co-secrete prolactin. A third option is the growth hormone receptor antagonist, pegvisomant, which acts peripherally to block the action of GH, normalizing IGF-1 levels even if GH remains elevated.
Ongoing management involves meticulous long-term monitoring to ensure the disease remains biochemically controlled. The endocrinologist regularly checks serum IGF-1 and GH levels, adjusting medication dosages to maintain hormone levels within the normal range. This continuous oversight prevents the return of hormonal excess and mitigates long-term complications.
Specialists in Tumor Reduction
When the pituitary adenoma is the source of excess growth hormone, specialists must reduce the tumor mass to offer the best chance for a cure. The neurosurgeon is typically the first specialist involved, performing transsphenoidal surgery (TSS). This procedure is the preferred initial treatment for most patients, offering rapid tumor debulking and a swift decrease in GH levels.
The neurosurgeon accesses the pituitary gland by navigating through the nasal cavity and the sphenoid sinus. Modern approaches utilize an endoscope, allowing for minimally invasive removal of the adenoma while sparing surrounding pituitary tissue. Achieving complete removal is linked to the surgeon’s experience and is more likely with smaller, non-invasive tumors.
If surgery is not entirely successful, or if the patient is not a suitable surgical candidate, the radiation oncologist provides targeted therapy. This intervention is often reserved as a second or third-line treatment to achieve long-term hormonal control. The most common technique is Stereotactic Radiosurgery (SRS), which delivers a high dose of radiation directly to the residual tumor.
Stereotactic Radiosurgery is a non-invasive procedure that uses precise imaging to converge multiple radiation beams on the tumor target, sparing healthy brain tissue. The effect is gradual, with hormonal levels decreasing slowly over several years as irradiated tumor cells lose their ability to secrete GH. During this period, the endocrinologist manages the patient with medical therapy until hormonal remission is achieved.
Coordinating Care for Associated Health Issues
Beyond tumor and hormonal control, acromegaly causes widespread systemic changes requiring a broad team of supporting specialists. The chronic excess of GH significantly impacts the cardiovascular system, making a cardiologist an essential part of the care team. They manage common complications like hypertension and cardiomyopathy, which is the enlargement and weakening of the heart muscle.
The physical overgrowth of soft tissue and bone affects the joints and skeleton, necessitating consultation with a rheumatologist or orthopedist. These specialists address joint pain, skeletal deformities, and conditions such as carpal tunnel syndrome that result from tissue proliferation. A sleep specialist is often involved due to the high incidence of obstructive sleep apnea, caused by the enlargement of the tongue and soft tissues in the throat.
Because the pituitary gland sits close to the optic nerves, tumor growth carries a risk of compressing these structures, leading to vision loss. An ophthalmologist or neuro-ophthalmologist monitors visual fields and acuity to detect early signs of nerve compression, which may prompt urgent surgical intervention. This collaborative approach ensures that immediate comorbidities are managed while the endocrinologist and neuro-interventional specialists focus on the underlying hormonal disorder.