Acromegaly surgery
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Acromegaly surgery On the Web |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
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 to be performed is endonasal transsphenoidal surgery.[1]
- Endonasal transsphenoidal surgery:
- Most of the patients with acromegaly due to pituitary adenoma undergo transsphenoidal surgery. It is a challenging operation due to the anatomical location of the pituitary gland.
- It is very successful in patients with adenoma smaller than 10 cm and GH level below 40ng.
- 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.
- 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:
- Local hemorrhage
- CSF leakage
- Diabetes insipidous
- 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:[2]
- GH level falls to the normal level within few hours.
- IGF-1 falls to the normal level within few days.
Indications
References
- ↑ Fahlbusch R, Honegger J, Buchfelder M (1992). "Surgical management of acromegaly". Endocrinol Metab Clin North Am. 21 (3): 669–92. PMID 1521518.
- ↑ 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.