Acromegaly surgery: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Acromegaly}} | {{Acromegaly}} | ||
{{CMG}} | {{CMG}}; {{AE}} {{AEL}} | ||
== Overview == | == Overview == | ||
Surgery is the mainstay of treatment for acromegaly due to [[pituitary adenoma]]. The goal of the surgery will be the removal of the [[pituitary]] mass that causes acromegaly. The best sugical technique is endonasal transsphenoidal surgery. | |||
==Surgery== | ==Surgery== | ||
*Surgery is the mainstay of treatment for acromegaly due to pituitary adenoma. The goal of the surgery will be the removal of the pituitary mass that causes acromegaly. The | *Surgery is the mainstay of treatment for acromegaly due to [[pituitary adenoma]]. The goal of the surgery will be the removal of the pituitary mass that causes acromegaly. The best sugical technique is endonasal transsphenoidal surgery.<ref name="pmid1521518">{{cite journal| author=Fahlbusch R, Honegger J, Buchfelder M| title=Surgical management of acromegaly. | journal=Endocrinol Metab Clin North Am | year= 1992 | volume= 21 | issue= 3 | pages= 669-92 | pmid=1521518 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1521518 }}</ref><ref name="pmid25356808">{{cite journal| author=Katznelson L, Laws ER, Melmed S, Molitch ME, Murad MH, Utz A et al.| title=Acromegaly: an endocrine society clinical practice guideline. | journal=J Clin Endocrinol Metab | year= 2014 | volume= 99 | issue= 11 | pages= 3933-51 | pmid=25356808 | doi=10.1210/jc.2014-2700 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25356808 }}</ref> | ||
=== '''Endonasal transsphenoidal surgery''' === | |||
Most of the patients with acromegaly due to [[pituitary adenoma]] undergo transsphenoidal [[surgery]]. Although it is a challenging operation due to the anatomical location of the [[pituitary gland]], tthe rate of complete successful resection in patients with adenomas smaller than 10 cm and [[GH]] level below 40ng is very high. It is important to remove the pituitary masses for this reasons: | |||
* They may invade the [[cavernous sinus]]. | |||
* They may be associated with [[Aneurysm|microaneurysms]]. | |||
MRI and CT imaging are used in guidance during the [[surgery]] and they have been linked with high safety and effectiveness of the surgery.<ref name="pmid12182410">{{cite journal| author=Lasio G, Ferroli P, Felisati G, Broggi G| title=Image-guided endoscopic transnasal removal of recurrent pituitary adenomas. | journal=Neurosurgery | year= 2002 | volume= 51 | issue= 1 | pages= 132-6; discussion 136-7 | pmid=12182410 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12182410 }}</ref> | |||
In case the surgery is performed successfully, the acral features of acromegaly will improve within days. | |||
Although it is very rare, some complications may occur. These complications include the following:<ref name="pmid19884662">{{cite journal| author=Melmed S| title=Acromegaly pathogenesis and treatment. | journal=J Clin Invest | year= 2009 | volume= 119 | issue= 11 | pages= 3189-202 | pmid=19884662 | doi=10.1172/JCI39375 | pmc=2769196 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19884662 }} </ref><ref name="pmid12186456">{{cite journal| author=Cappabianca P, Cavallo LM, Colao A, de Divitiis E| title=Surgical complications associated with the endoscopic endonasal transsphenoidal approach for pituitary adenomas. | journal=J Neurosurg | year= 2002 | volume= 97 | issue= 2 | pages= 293-8 | pmid=12186456 | doi=10.3171/jns.2002.97.2.0293 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12186456 }} </ref> | |||
* [[Hemorrhage|Local hemorrhage]] | |||
* [[CSF]] leakage | |||
* [[Diabetes insipidus]] | |||
* [[Infection]] | |||
* [[Meningitis]] | |||
* Damage of the normal [[Pituitary gland|pituitary tissue]] | |||
Postoperatively, [[somatostatin]] analogs and [[radiotherapy]] are recommended in case of remaining excess of [[growth hormone]]. | |||
Indicators of successful surgery:<ref name="pmid16159936">{{cite journal| author=Feelders RA, Bidlingmaier M, Strasburger CJ, Janssen JA, Uitterlinden P, Hofland LJ et al.| title=Postoperative evaluation of patients with acromegaly: clinical significance and timing of oral glucose tolerance testing and measurement of (free) insulin-like growth factor I, acid-labile subunit, and growth hormone-binding protein levels. | journal=J Clin Endocrinol Metab | year= 2005 | volume= 90 | issue= 12 | pages= 6480-9 | pmid=16159936 | doi=10.1210/jc.2005-0901 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16159936 }}</ref> | |||
* [[GH]] level falls to the normal level within few hours. | |||
* [[IGF-1]] falls to the normal level within few days. | |||
A video showing the procedure of endonasal transsphenoidal surgery:{{#ev:youtube|v=xllKSOXDuNM|}} | |||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
Latest revision as of 18:58, 24 August 2017
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American Roentgen Ray Society Images of Acromegaly surgery |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ahmed Elsaiey, MBBCH [2]
Overview
Surgery is the mainstay of treatment for acromegaly due to pituitary adenoma. The goal of the surgery will be the removal of the pituitary mass that causes acromegaly. The best sugical technique is endonasal transsphenoidal surgery.
Surgery
- Surgery is the mainstay of treatment for acromegaly due to pituitary adenoma. The goal of the surgery will be the removal of the pituitary mass that causes acromegaly. The best sugical technique is endonasal transsphenoidal surgery.[1][2]
Endonasal transsphenoidal surgery
Most of the patients with acromegaly due to pituitary adenoma undergo transsphenoidal surgery. Although it is a challenging operation due to the anatomical location of the pituitary gland, tthe rate of complete successful resection in patients with adenomas smaller than 10 cm and GH level below 40ng is very high. It is important to remove the pituitary masses for this reasons:
- They may invade the cavernous sinus.
- They may be associated with microaneurysms.
MRI and CT imaging are used in guidance during the surgery and they have been linked with high safety and effectiveness of the surgery.[3]
In case the surgery is performed successfully, the acral features of acromegaly will improve within days.
Although it is very rare, some complications may occur. These complications include the following:[4][5]
- Local hemorrhage
- CSF leakage
- Diabetes insipidus
- Infection
- Meningitis
- Damage of the normal pituitary tissue
Postoperatively, somatostatin analogs and radiotherapy are recommended in case of remaining excess of growth hormone.
Indicators of successful surgery:[6]
- GH level falls to the normal level within few hours.
- IGF-1 falls to the normal level within few days.
A video showing the procedure of endonasal transsphenoidal surgery:{{#ev:youtube|v=xllKSOXDuNM|}}
References
- ↑ Fahlbusch R, Honegger J, Buchfelder M (1992). "Surgical management of acromegaly". Endocrinol Metab Clin North Am. 21 (3): 669–92. PMID 1521518.
- ↑ Katznelson L, Laws ER, Melmed S, Molitch ME, Murad MH, Utz A; et al. (2014). "Acromegaly: an endocrine society clinical practice guideline". J Clin Endocrinol Metab. 99 (11): 3933–51. doi:10.1210/jc.2014-2700. PMID 25356808.
- ↑ Lasio G, Ferroli P, Felisati G, Broggi G (2002). "Image-guided endoscopic transnasal removal of recurrent pituitary adenomas". Neurosurgery. 51 (1): 132–6, discussion 136-7. PMID 12182410.
- ↑ Melmed S (2009). "Acromegaly pathogenesis and treatment". J Clin Invest. 119 (11): 3189–202. doi:10.1172/JCI39375. PMC 2769196. PMID 19884662.
- ↑ Cappabianca P, Cavallo LM, Colao A, de Divitiis E (2002). "Surgical complications associated with the endoscopic endonasal transsphenoidal approach for pituitary adenomas". J Neurosurg. 97 (2): 293–8. doi:10.3171/jns.2002.97.2.0293. PMID 12186456.
- ↑ Feelders RA, Bidlingmaier M, Strasburger CJ, Janssen JA, Uitterlinden P, Hofland LJ; et al. (2005). "Postoperative evaluation of patients with acromegaly: clinical significance and timing of oral glucose tolerance testing and measurement of (free) insulin-like growth factor I, acid-labile subunit, and growth hormone-binding protein levels". J Clin Endocrinol Metab. 90 (12): 6480–9. doi:10.1210/jc.2005-0901. PMID 16159936.