Recent developments in the treatment of acromegaly

Abstract

In acromegaly the microsurgical transsphenoidal removal of the pituitary adenoma has become the most widely used method of treatment. In experienced hands, the therapeutic goal of rapid normalization of hormone excess and preservation of pituitary function can be achieved in most of the patients if the tumours are not too large. Medical treatment or radiotherapy alone, or in combination, are less successful for primary treatment. They are indispensable as alternative therapy in those patients not suitable for operation, and as additional methods after incomplete tumour removal. Large invasive adenomas still present a challenge for further improvement of therapeutic facilities. Intraoperative GH-measurements, as recently introduced by us, help to identify tumour residues and justify additional surgical exploration at higher risk.

Transsphenoidal Microsurgery for Newly Diagnosed Acromegaly: A Personal View after More than 1,000 Operations

“…According to the old criteria (GH <4.5 ng/ml and <2 ng/ml in oral glucose tolerance), this patient was normalized after additional transnasal surgery [2]. In our series until 2002, only 8 (0.8%) of 1,006 operations in acromegaly were performed by a transcranial, mostly subfrontotemporal, approach.…”

“…In our first larger evaluation of 305 primary operations in acromegaly from 1970 to 1984 performed by Lüdecke [2], a primary transcranial approach was used only once.…”

“…Therefore, the time-consuming method of intraoperative growth hormone (GH) measurement with the option of further surgery was introduced in 1983, independently by Yamada et al[ 8] in Tokyo and Lüdecke [2] in Hamburg. Improvement in the results of resectable adenomas was documented, and secondary therapies could be more often avoided [2, 8]. For unknown reasons, this unique endocrine technique has been rarely used or mentioned in reviews on the therapy of acromegaly.…”

“…We abandoned sublabial surgery in 1978 and performed all operations – even on children – by direct intranasal access [2]. Today, three main transnasal techniques are established: (1) microsurgery facing the patient in a standing or sitting position [2], (2) microsurgery standing behind the patient’s head [3], and (3) the endoscopic approach, facing the patient and TV screen [4]. Techniques and results of these different methods presented at the Meeting on Growth Hormone in November 2005 in Athens will be described in detail.…”

Preoperative Treatment of Growth Hormone-Producing Pituitary Adenoma with Continuous Subcutaneous Infusion of Octreotide.

“…Key words: Acromegaly, Octreotide, Continuous subcutaneous infusion, GH, Tumor shrinkage (Endocrine Journal 45: 269-275,1998) THE primary treatment for GH-producing pituitary adenomas is transsphenoidal surgical excision, but plasma GH levels are suppressed to below 5 ng/ ml after surgery in only about 60% of patients with acromegaly [1][2][3][4]. On the other hand, the treatment with a long-acting somatostatin analog, octreotide, reduces GH hypersecretion in up to 90% of acromegalic patients [5], and induces shrinkage of the tumor size in approximately 50% of GHproducing tumors [6,7].…”