[Acromegaly--diagnosis and treatment].
BACKGROUND
Acromegaly is a rare but clinically important disease caused by growth hormone hypersecretion, usually from a pituitary adenoma. The condition is associated with increased morbidity and mortality.


METHODS
The prevalence of acromegaly is estimated to be 4-6 cases per million per year. The diagnosis is based on glucose-suppressed plasma growth hormone. When the diagnosis is confirmed, MR imaging of the pituitary gland is performed.


RESULTS
Standard treatment is transsphenoidal microsurgery; however, radicality is often difficult because of extensive tumour growth. Preoperative administration of somatostatin analogues may improve the surgical outcome.


CONCLUSIONS
We have initiated a randomized, prospective study to elucidate this adjuvant treatment. Somatostatin analouges are required in the case of postoperative activity. This treatment is without tachyphylaxis and has few side effects. Alternatively, dopamine agonists such as bromocriptine can be used, especially in mixed tumours coproducing prolactin. Newer, more specific dopamine agonists are currently being evaluated. Radiation therapy may be required in large, unresectable tumours, but the effects are slow-acting, and almost all patients develop hypopituitarism. Gamma knife radiosurgery seems promising for stopping tumour growth as well as for decreasing excessive hormone production. However long-time follow-up results are so far lacking.
Bollerslev
J
J
Medisinsk Avdeling, Rikshospitalet, Oslo. jens.bollerslev@rikshospitalet.no
D000172:Acromegaly / Q000175:diagnosis* / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D000239:Adenoma, Acidophil / Q000175:diagnosis / Q000628:therapy; D000328:Adult; D003937:Diagnosis, Differential; D005260:Female; D019382:Human Growth Hormone / Q000097:blood; D006801:Humans; D007016:Hypophysectomy; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010902:Pituitary Gland / Q000473:pathology / Q000528:radiation effects; D010911:Pituitary Neoplasms / Q000175:diagnosis / Q000628:therapy; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic
D019382:Human Growth Hormone