Successful Treatment of Acromegaly

A 49-year-old man was referred by his dentist to Dr. Adriana Ioachimescu at the Neuroendocrine Clinic for treatment of a severe underbite. He had a history of hypertension. Upon questioning, it was discovered that he had experienced an increase in shoe size and snoring for at least three years. A physical exam demonstrated significant features of acromegaly.

A pituitary hormone panel revealed that his insulin growth factor 1 (IGF-1, somatomedin C) was significantly elevated at 1272 ng/mL (five times above normal). His growth hormone level did not suppress upon glucose challenge, remaining 20 times above normal. The test also showed impaired glucose tolerance. Other pituitary hormone levels were normal. In addition, an echocardiogram showed septal hypertrophy. Subsequent magnetic resonance imaging (MRI) showed a 1.6-cm pituitary tumor with a compression effect on the optic chiasm.

The patient was referred to Nelson Oyesiku, MD, PhD, FACS, who performed 3-D transsphenoidal endoscopic surgery. The patient tolerated surgery well, and two days following the procedure, his growth hormone level decreased to 0.62 ng/mL. The patient was discharged on postoperative day three and did not experience any endocrine or neurosurgical complications.

At a follow-up visit three months after surgery, testing revealed normal growth hormone suppression during glucose challenge and mid-normal IGF-1 of 189 ng/mL. An MRI scan showed complete tumor resection. Acromegaly causes significant comorbidities (e.g., hypertension, diabetes mellitus, heart problems, obstructive sleep apnea) and increased mortality two to three times above the general population. Also, growth hormone-secreting tumors are usually large and may lead to mass effect symptoms (e.g, headaches, vision problems). These can be prevented or halted if biochemical control is achieved by means of surgery and adjuvant therapies, such as medications and radiation.

At the Emory Pituitary Center, transsphenoidal resection of noninvasive growth hormone-secreting pituitary adenomas have a 70% chance of postoperative remission and a very low recurrence rate of 3%. These statistics are based on the electronic database review of 70 patients with acromegaly operated by Dr. Oyesiku over a period of 12 years. Emory research shows that growth hormone levels lower than 2.2 mcg/dL in the first two postoperative days are predictive of surgical success in most (but not all) cases.