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 to 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-1 levels, control or prevent progression of disease, and relieve associated comorbidities

Transsphenoidal Surgery

  • Treatment of choice for all patients with microadenomas and or all patients who have macroadenomas with associated mass effect eg causing visual impairment
    • In patients with macroadenomas without mass effects but 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
  • Some clinicians have found benefits with the use of somatostatin receptor ligands (SRL) prior to surgery
    • Some have claimed pretreatment with SRLs has improved normalization of growth hormone and insulin-like growth factor-1 after surgery and shortened the duration of hospital stay
Outcomes
  • Surgical cure rates are dependent on anatomy, extent and invasion of tumor and neurosurgeon expertise
  • Cure rates for intrasellar microadenomas and macroadenomas are high with an experienced neurosurgeon and facility
  • Control suggests GH levels <1 ng/mL (with IRMA or chemiluminescence assay after a 75-g oral glucose followed by GH measurements every 30 minutes for 120 minutes) and normalized age and gender matched IGF-1 levels and alleviation of tumor mass effects
  • Repeat surgery can be considered in patients with residual intrasellar disease following initial surgery and when the tumor is accessible
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
01 Dec 2020
Tetanus toxoid 5 Lf, diphtheria toxoid 2 Lf, pertussis toxoid 2.5 mcg, filamentous haemagglutinin 5 mcg, fimbriae types 2 and 3 5 mcg, pertactin 3 mcg
Dr. Hsu Li Yang, Dr. Tan Thuan Tong, Dr. Andrea Kwa, 08 Jan 2021
Antimicrobial resistance has become increasingly dire as the rapid emergence of drug resistance, especially gram-negative pathogens, has outpaced the development of new antibiotics. At a recent virtual symposium, Dr Hsu Li Yang, Vice Dean (Global Health) and Programme Leader (Infectious Diseases), NUS Saw Swee Hock School of Public Health, presented epidemiological data on multidrug-resistant (MDR) gram-negative bacteria (GNB) in Asia, while Dr Tan Thuan Tong, Head and Senior Consultant, Department of Infectious Diseases, Singapore General Hospital (SGH), focused on the role of ceftazidime-avibactam in MDR GNB infections. Dr Andrea Kwa, Assistant Director of Research, Department of Pharmacy, SGH, joined the panel in an interactive fireside chat, to discuss challenges, practical considerations, and solutions in MDR gram-negative infections. This Pfizer-sponsored symposium was chaired by Dr Ng Shin Yi, Head and Senior Consultant of Surgical Intensive Care, SGH.
Pearl Toh, 26 Nov 2020
Inhaled corticosteroid (ICS) should be the mainstay of long-term asthma management — such is the key message of the latest Singapore ACE* Clinical Guidance (ACG) for asthma, released in October 2020.
Audrey Abella, 5 days ago
A pilot telemedicine initiative may be an alternative for facilitating delivery of intravenous iron (IVI) for individuals requiring iron supplementation.