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Radiosurgery as primary management for acromegaly.

Hugh P Sims-Williams1, Kaveesha Rajapaksa1, Saurabh Sinha1

  • 1Department of Neurosurgery, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.

Clinical Endocrinology
|October 6, 2018
PubMed
Summary

Stereotactic radiosurgery (STRS) for acromegaly shows good long-term efficacy with low morbidity, but requires extended follow-up due to delayed biochemical control and hypopituitarism. This treatment is a viable alternative when surgery is not feasible.

Keywords:
IGF1acromegalygrowth hormonehypopituitarismmorbiditypituitary adenomasradiosurgery

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Area of Science:

  • Endocrinology
  • Neurosurgery
  • Radiation Oncology

Background:

  • Transsphenoidal surgery (TSS) is the primary treatment for acromegaly.
  • Long-term outcomes for primary stereotactic radiosurgery (STRS) are not well-established.

Purpose of the Study:

  • To evaluate the long-term efficacy and safety of primary STRS for acromegaly.
  • To assess biochemical control, hypopituitarism, morbidity, and mortality after STRS.

Main Methods:

  • Retrospective cohort study of 20 acromegaly patients treated with primary STRS.
  • Data collected via chart review, laboratory results, physician notes, questionnaires, and death certificates.
  • Follow-up included biochemical control (GH/IGF1), hypopituitarism, morbidity, and mortality assessments.

Main Results:

  • At 20 years, 100% of patients on medication and 75% off medication achieved biochemical control.
  • New-onset hypopituitarism developed in 53% of patients, with onset as late as 20 years post-treatment.
  • Low morbidity was observed, with no STRS-related deaths, though 3 patients required subsequent TSS.

Conclusions:

  • STRS offers good long-term efficacy for acromegaly, particularly when combined with optimal medical management.
  • Significant latency to biochemical control and hypopituitarism necessitates very long-term patient follow-up.
  • STRS is a valuable alternative treatment option for acromegaly when TSS is not feasible.