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Options Improving for Patients With Acromegaly and Gigantism

including abnormal enlargement of the extremities, soft-tissue swelling, joint and spine conditions, protrusion of the jaws, and high blood sugar levels even when fasting. Patients often suffer from such complications as heart and valve disorders, high blood pressure and respiratory dysfunction.

“In addition to the variety of medical conditions, self-image is a major issue for these patients. At Cedars-Sinai, we have support groups in which patients can share their experiences with a professional counselor, and we offer the option of cosmetic surgery, especially for the jaw,” said Melmed. “We also have patient days that give patients the opportunity to meet with our physician experts and the coordinators of our support groups.”

Nearly all cases of acromegaly are caused by tumors of the pituitary gland. More than 90 percent of patients with acromegaly have a slow-growing type of tumor that is found in adults over 50 years of age. Younger patients usually have a more rapidly growing tumor, and a third type of tumor, commonly encountered by patients in their teens, often causes gigantism.

In general, ideal treatment includes surgery to remove the tumor, followed by medical therapy to manage or reverse any coexisting conditions. In many cases, however, the tumor may have grown too large or is positioned too close to vital structures for complete surgical removal to be possible or practical. Also, not all patients are good candidates for surgery.

Improvements in radiation therapy and radiosurgery, along with advances in computerized imaging systems, have improved targeting of a tumor mass, minimized radiation damage to normal surrounding tissues, and reduced treatment times. Also in the past two decades, new medications have been introduced, working at the cellular and molecular levels to suppress the secretion of growth hormone, interrupt the proliferation of somatotroph cells, and block the synthesis of IGF-I. High cost
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