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Surgery for acromegaly: Indications and goals.

David P Bray1, Sai Mannam1, Rima S Rindler2

  • 1Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA, United States.

Frontiers in Endocrinology
|August 22, 2022
PubMed
Summary

Acromegaly, caused by excess growth hormone (GH) from pituitary tumors, requires diagnosis via GH and IGF-1 levels and pituitary MRI. Surgical removal of the adenoma is the primary treatment, with medical and radiation options for persistent disease.

Keywords:
acromegalyadenomaendonasalendoscopicpituitaryskull-basetransnasal

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Area of Science:

  • Endocrinology
  • Oncology
  • Neurosurgery

Background:

  • Acromegaly results from excessive growth hormone (GH) production, typically due to a pituitary adenoma.
  • This hormonal imbalance leads to significant multisystem complications.
  • Early diagnosis and intervention are crucial for managing acromegaly.

Purpose of the Study:

  • To outline the diagnostic criteria for acromegaly.
  • To describe the primary surgical treatment approach.
  • To present alternative therapies for cases not achieving biochemical remission post-surgery.

Main Methods:

  • Diagnosis involves assessing serum GH and IGF-1 levels.
  • Pituitary MRI with a specific protocol is used to identify functional pituitary adenomas.
  • Surgical resection of the GH-secreting adenoma is the initial therapeutic strategy.

Main Results:

  • Biochemical remission is the primary goal of surgical intervention.
  • Gross total resection aims for complete tumor removal.
  • Non-responders to surgery may require further medical or radiation treatment.

Conclusions:

  • Surgical adenoma resection is the gold standard for acromegaly treatment.
  • Multidisciplinary approaches are necessary for comprehensive patient care.
  • Medical and radiation therapies serve as essential adjuncts to surgery.