Monica Gadelha, PhD, Professor of Medicine at the University of Rio De Janeiro discusses symptoms and how symptoms for Acromegaly patients are managed.
Transcription:
There are two main problems with managing acromegaly. First, let me define acromegaly. Acromegaly is a disease that in the vast majority of cases, I would say 98% of them, is caused by a tumor, a benign tumor in the pituitary that secretes growth hormones. GH leads to an increase in IGF-1 that is the hormone that promotes most of the size and symptoms of acromegaly.
One of the problems of the disease is that people and physicians are not familiar with the disease. The disease has many signs and symptoms. The increase in hands and feet, the features of the face are more, I would say, different. Increasing nose, and lips. Hypertension, diabetes, arthralgia, and paresthesia, the risk of colon cancer, so many complications. These patients go to the cardiologist, to the rheumatologist, to the general practitioner, but nobody think about acromegaly. It’s a disease that many, many people are not familiar with.
The other problem is that the disease is very insidious. It’s a slow and progressive disease. People that are very close to the patient don’t realize that the patient is changing. But for example, if the patient meets someone that he or she hasn’t seen for many years, this person will notice that the patient is very different. But people don’t know what’s happening. This change in appearance is associated with a lot of loss of quality of life because the patient doesn’t understand what’s going on. But he feels ugly, he feels fatigued, he feels bad, but he doesn’t understand.
On top of that, hypertension, diabetes, arthropathy, so a very slow-growing and debilitating and aggressive disease. Regarding mortality, if the disease is not controlled and the mortality is increased, it may be 1.7 up to three times the normal population. We need to control the disease. We need to have normal IGF-1 and GH, mainly IGF-1, but ideally also GH. Otherwise, this patient is at risk of having precocious mortality.
These are the main problems of the disease. The primary treatment of acromegaly surgery. The patient should be referred to a referral center. It’s very, very important that the patient is operated on in the referral center. One of the definitions of a referral center is a center that has a neurosurgeon that does at least one pituitary surgery per week. I mean, 50 per year, ideally 100. Also, the center has to have a neuroendocrinologist and the whole team.
The primary treatment is surgery. Surgery will cure the patient in approximately 50% of the case. This in referral centers, because if it’s not in a referral center, it could be close to zero or 10%. But in referral centers, the average is 50%. This means that the other 50% will need more treatment that are usually the drugs. Radiotherapy is reserved for more aggressive diseases because the patient may get some important complications with radiotherapy. We reserve radiotherapy for more aggressive tumors. Usually when the patient is not cured by surgery, we put them on drugs.
To learn more about this and other endocrine disorders, visit checkrare.com/diseases/endocrine-disorders/