Treatment Options for Growth Hormone (GH)–Producing Pituitary Tumors

Treatment options for GH-producing pituitary tumors include:

Treatment for patients with acromegaly includes surgical, radiation, and medical therapies.[3] Treatment depends on the size and extent of the tumor and the need for rapid cessation of hormone function that results in serious clinical sequelae (i.e., hypertension and cardiomyopathy).

Microadenomectomy or macroadenoma decompression is approached transsphenoidally in most patients. Increasingly, endoscopic surgery is used to allow the entire surgical field to be viewed and to allow tumor tissue that would otherwise be inaccessible with rigid instruments to be safely resected. However, normalization of GH levels is not often achieved. Increasingly, adjuvant radiation therapy is reserved for tumors that extend beyond the safe operative area and appear to pose an ongoing threat.

Drug treatment, whether used as an adjuvant or primary therapy in appropriately selected patients,[4] includes the use of somatostatin analogues, such as octreotide; dopamine analogues, such as bromocriptine; and, the GH-receptor antagonist pegvisomant. As the first of a new class of GH-receptor antagonists, pegvisomant works by inhibiting functional dimerization of GH receptors, inhibiting GH action. Results indicate that it may be the most effective medical treatment for acromegaly.[1,2]

In acromegalic patients, impaired glucose tolerance, hypertension, and hyperlipidemia should be vigorously treated concurrently with definitive therapy. A multidisciplinary clinical approach may be required for the treatment of arthritis, carpal tunnel syndrome, obstructive sleep apnea, and prognathism.[5] Mortality is related primarily to cardiovascular and respiratory diseases.[5]