Changing paradigms in the surgical and medical management of acromegaly

Acromegaly is a serious, but rare, form of pituitary tumor. This review will discuss recent progress in surgical and medical care, highlight data on choosing the order for primary and secondary therapy and preview emerging drugs. Several controversial areas will be discussed, including the role of preselecting subjects for drug responsiveness, whether or not a brief course of medical therapy before surgery improves outcomes, and trials of combination drug therapy. It is hoped that earlier diagnosis, referral of patients to dedicated pituitary surgeons or neuroendocrinology teams, development of more effective and affordable drugs, and further advances in surgery and radiotherapy will continue to improve the morbidity and mortality from acromegaly.