Clinical Management of Acromegaly

     Though insulin-like growth factor-2, which originates in the liver, does exist, one must not confuse it with insulin-like growth factor-1.  In fact, insulin-like growth factor-2 has to do with growth of the fetus in pregnant women but no connection with acromegaly.  There is good reason to obtain a blood test for insulin-like growth factor-1 in patients who may have acromegaly.  However, laboratory assays for insulin-like growth factor-2 have no benefit for the evaluation of patients with that disease [1, 2].

     Some patients will benefit from a growth hormone suppression test in which the physician administers 75 grams of oral glucose two hours before the laboratory staff draws blood to measure the level of growth hormone.  The diagnosis of acromegaly is present when this test does not suppress growth hormone level in the blood.  In other words, suppression is the body’s normal response to administration of oral glucose [1, 2].

     Magnetic resonance imaging is a sensitive method that may identify the presence of a pituitary adenoma.  In fact, it can detect an adenoma as small as two millimeters in diameter.  It is important to assess the client’s kidney function prior to the performance of this test as the contrast material poses a contraindication when there is impairment of renal function [1, 2].

     Of course, there are many hormonal assays to determine how well the endocrine system operates.  Some of these include measurement of thyroid-stimulating hormone, thyroxine, follicle-stimulating hormone, cortisol, luteinizing hormone, testosterone, and prolactin [1, 2].

     Moreover, a visit to the ophthalmologist is especially important as these patients may suffer from visual defects.  This happens because nerve fibers that cross in the brain—at the optic chiasm—function improperly because the adenoma exerts pressure there.

     Though the results of examination and evaluation determine which approach the health care team will use, surgery is the most common method for these clients.  Specifically, transsphenoidal surgery involves resection of the tumor.  This generally leads to reduction in growth hormone levels as resolution of facial swelling and other abnormalities lessen.  In essence, pressure on the brain declines after surgery [1, 2].

     Finally, other methods such as medication and radiation have been useful for some of these clients [1, 2].

     Acromegaly is an interesting disease which medical doctors have long encountered.  Early intervention and diagnosis will afford the best possible outcome, and in these patients, the result will often be quite favorable.

1. Kravets, I.  (2017).  Big Heart, small ring.  Cleveland Clinic Journal of Medicine, 84, 925-933.
2. National Institute of Diabetes and Digestive and Kidney Diseases.  (2012).  Acromegaly.
3. The photo shows a library at the U.S. Centers for Disease Control and is reprinted with permission from that organization.
4. Copyright 2018.  Michael Koger, Sr.  All rights reserved.

     The information contained in this article is for educational purposes only, and one should not use it for diagnosis or treatment without the opinion of a health professional. Any reader who is concerned about his or her health should contact their physician for advice.