Acromegaly: the disease, its impact on patients, and managing the burden of long-term treatment

Abstract

Acromegaly is a rare disease most often caused by the prolonged secretion of excess growth hormone from a pituitary adenoma. The disease is associated with multiple significant comorbidities and increased mortality. The delay to diagnosis is often long. This may be because of low disease awareness among health care professionals, the insidious onset of differentiating features, and because patients are likely to present with complaints typical of other conditions more frequently seen in primary care. Early identification of acromegaly facilitates prompt treatment initiation and may minimize the permanent effects of excess growth hormone. The primary treatment for many patients will be pituitary surgery, although not all patients will be eligible for surgery or achieve a surgical cure. If biochemical control is not achieved following surgery, other treatment options include medical therapy and radiation therapy. Improved biochemical control may only alleviate rather than reverse the associated comorbidities. Thus, lifelong monitoring of patient health is needed, with particular attention to the management of cardiovascular risk factors. It is additionally important to consider the impact of both disease and treatment on patients' quality of life and minimize that impact where possible, but particularly for chronic therapies. For the majority of patients, chronic therapy is likely to include somatostatin analog injections. In some circumstances, it may be possible to extend the dosing interval of the analog once good biochemical control is achieved. Additional convenience may be gained from the possibility of self-/partner administration of treatment or administration of treatment by a health care professional at home. Overall, it is clear that the care of patients with acromegaly requires a highly coordinated approach involving numerous specialties (eg, endocrinology, surgery, cardiology). Further, patients' needs must be at the core of management and every effort must be made to improve health care experiences and minimize treatment burdens.

Keywords: acromegaly; convenience; diagnosis; quality of life; treatment.

Figure 1

The pituitary gland. Note: Reproduced with permission from Harris AG, Daly AF. Treatment of acromegaly. In: Acromegaly and Its Management. Philadelphia, PA: Lippincott-Raven; 1996:49–68. Copyright Lippincott Williams & Wilkins, 1996.

Figure 2

Signs and symptoms of acromegaly. Note: Reproduced with permission from Harris AG, Daly AF. Treatment of acromegaly. In: Acromegaly and Its Management. Philadelphia, PA: Lippincott-Raven; 1996:49–68. Copyright Lippincott Williams & Wilkins, 1996.

Figure 3

Gradual change in facial features in acromegaly (prior to diagnosis). Note: This article was published in Molitch ME. Clinical manifestations of acromegaly. Endocrinol Metab Clin North Am. 1992;21(3):597–614. Copyright Elsevier 1992.

Figure 4

(A) Time associated with lanreotide depot^a and octreotide long-acting release (LAR) injections and (B) distance traveled to clinic for an octreotide LAR injection. Notes: Data are for 33 patients switching from previous octreotide LAR injections in a prospective open-label 24-week study conducted in the USA (Ipsen, unpublished data, 2009). Patients completed a questionnaire at week 0 related to the convenience of the previous octreotide LAR injections received from a health care professional. Patients opting to self-/partner administer lanreotide depot injections were instructed on injection technique by a health care professional at week 0, but patients/partners administered all study injections themselves (once every 28 days). Patients completed convenience questions relating to lanreotide at weeks 0 and 24. ^aSomatuline^® depot is known as Somatuline^® Autogel^® (Ipsen Pharma Biotech, Signes, France) outside the USA.