acromegaly
ACROMEGALY
Acromegaly is a chronic, slowly developing disease with progressive disfigurement and disability. An early diagnosis is difficult as most signs and symptoms are due to long-standing overproduction of growth hormone &/or insulin-like growth factor (IGF-I) causing metabolic, endocrine and morphological changes.
Surgical intervention is the first-line of treatment for almost all patients with acromegaly unless there are contraindications or the patient refuses to undergo the procedure.

Surgical Intervention

Surgical intervention is the 1st-line of treatment for almost all patients with acromegaly unless there are contraindications or the patient refuses to undergo the procedure

Patients not Eligible for Surgical Treatment

  • Medically unstable condition
  • Patients with airway difficulties and are at high risk for anesthetic complications
  • Major systemic manifestations of acromegaly:
    • Cardiomyopathy
    • Severe hypertension
    • Uncontrolled diabetes mellitus

Goals of Surgical Treatment:

  • To decrease tumor burden, and cure if possible, with preservation of normal pituitary function
  • To reduce mass effect of macroadenomas on remaining normal pituitary gland tissues, the optic chiasm or nerves, and other surrounding structures
  • To rapidly lower or reduce growth hormone and insulin-like growth factor-I levels, control or prevent progression of disease, and relieve associated comorbidities

Transsphenoidal Surgery

  • Treatment of choice for all patient with microadenomas and or all patients who have macroadenomas with associated mass effect
    • In patients with macroadenomas without mass effects, and low likelihood of surgical cure, surgical debulking may improve response to subsequent medical therapy
    • Primary medical therapy alone has also been advocated for those with macroadenomas not likely to be cured by surgery
  • Transnasal endoscopic procedures have shown improved patients satisfaction and shorter hospital stay compared with traditional sublabial procedures, without compromising surgical success
  • In noninvasive macroadenomas, biochemical control with normalization of insulin-like growth factor-I occurs in 40-68% of the patients
  • In intrasellar microadenomas, surgery provides biochemical control and normalization of insulin-like growth factor-I in 75-95% of patients
  • Surgery requires expertise to achieve control rates
  • Some clinicians have found benefits with the use of somatostatin receptor ligands (SRL) prior to surgery
    • Some have claimed pretreatment with SRLs have improved normalization of growth hormone and insulin-like growth factor-I after surgery and shorten the duration of hospital stay
Digital Edition
Asia's trusted medical magazine for healthcare professionals. Get your MIMS Endocrinology - Malaysia digital copy today!
Sign In To Download
Editor's Recommendations
Most Read Articles
08 Jun 2018
Passive smoking at home and in the workplace as well as having a family history of diabetes mellitus increase the risk of gestational diabetes mellitus (GDM), according to a recent China study.
Pearl Toh, 05 Jun 2018
Asian patients with end-stage renal failure (ESRF) had almost triple the risk of death within 1 year after hip fracture surgery, making ESRF an independent predictor for 1-year mortality, a recent study found.
Stephen Padilla, 06 Jun 2018
The amount of added sugars in the diet, especially when present in processed foods, appears to increase the risk of frailty in older people, a recent study suggests. Low levels of physical activity and unintentional weight loss are the frailty components more closely associated with added sugars.
Dr Joslyn Ngu, 4 days ago

The transcultural Diabetes Nutrition Algorithm (tDNA) which involves a structured low-calorie meal plan, diabetes-specific meal replacements and enhanced physical activity, is effective for weight loss in patients with type 2 diabetes, a local study shows. [BMJ Open Diabetes Res Care 2017;5(1):e000384. Doi:10.1136/bmjdrc-2016-000384th]