Diagnosis | Acromegaly


As with any procedure for finding a diagnosis, the medical history can provide information: Do old rings still fit, has the shoe size changed? The comparison with old photographs can help. In endocrinology (the science of hormones), various levels in the blood can be measured:

  • Do old rings still fit, has the shoe size changed?
  • The comparison with old photographs can help. – IGF 1 in plasma: since IGF 1 is stimulated by somatotropin (STH), it reflects the STH levels
  • Basal STH – mirror: a daytime profile must be created, since STH is released in varying concentrations at different times of the day (most of the time at night)
  • STH- values in the TRH and LHRH test: it is tested whether the growth hormone is pathological (i.e. The hormones TRH (stimulates the release of TSH, which stimulates the thyroid gland) and LHRH (stimulates the release of LH and FSH, which influence the maturation of sperm in men and egg cells in women) measure the function of the anterior pituitary gland (HVL) by measuring the concentration of the influenced hormones (TSH, FSH and LH). If the concentration does not increase, there is a disorder of the anterior pituitary lobe (HVL).

Acromegaly therapy

If the cause is a benign microadenoma (small adenoma) it can be surgically removed. Approx. 90% of cases are clinically cured.

However, if the adenoma of the pituitary gland is larger than 10mm (macroadenoma = large adenoma), it can also be removed surgically, but it will only be completely removed in about 60% of cases. The result can be seen immediately after the operation because the IGF 1 level drops. However, the clinical symptoms will only disappear slowly over weeks and months.

In patients for whom surgery is out of the question or if the surgical therapy fails, radiation can provide relief. For this purpose, CT (computed tomography) or MRT (magnetic resonance imaging) images are taken and, with the help of a computer program, radiation plans tailored to each individual patient are drawn up. These include the strength, localisation and frequency of the radiation.

However, the full effect only occurs after a few years. Drug therapy can also be used. This is used, for example, if an operation or radiation cannot be performed, or in preparation for both.

Somatostatin analogues (substances that correspond to somatostatin and have the same effect: octreotide, lanreotide) and dopamine agonists (substances that have the same effect as dopamine; dwiropamine is the precursor of adrenaline) are given. The somatostatin analogues lead to a reduction of the STH level in many patients (80-95%). In half of the patients, there is even a shrinkage of the adenoma.

A disadvantage is that the hormone is injected under the skin and is relatively expensive. However, it is also increasingly injected into the muscle, where it has a depot effect for 2-4 weeks. Problems can occur at the beginning of the therapy which affect the gastrointestinal tract (e.g. diarrhoea).

An advantage, however, is that the effect can be assessed quickly (within hours). Unfortunately, only about 25% of patients respond to dopamine agonists. The dopamine agonist cannot cause a shrinkage of the adenoma either.

The effect can be assessed within a few weeks (6-8). A relatively new development is a receptor antagonist, which prevents the effect of STH at the docking site (receptor) of the hormone. It does not lead to a direct reduction of the STH concentration. It is used, just like the other drugs, when surgical therapy or radiation has either not been effective or is not possible.