Skip to main content
SpringerLink
Log in

Acromegaly: Surgical Management

  • Chapter
Diagnosis and Management of Pituitary Disorders

Part of the book series: Contemporary Endocrinology ((COE))

  • 1689 Accesses

Summary

Although medical alternatives now exist, transsphenoidal surgery remains the primary therapy in the management of acromegaly. This chapter describes the indications for surgery, techniques, and complications, as well as management strategies for persistent and recurrent disease.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 169.00
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 249.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 219.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Rajasoorya C, Holdaway IM, Wrightson P, Scott DJ, Ibbertson HK. Determinants of clinical outcome and survival in acromegaly. Clin Endocrinol (Oxf) 1994;41:95–102.

    CAS  Google Scholar 

  2. Orme SM, McNally RJ, Cartwright RA, Belchetz PE. Mortality and cancer incidence in acromegaly: a retrospective cohort study. United Kingdom Acromegaly Study Group. J Clin Endocrinol Metab 1998;83:2730–4.

    Article  PubMed  CAS  Google Scholar 

  3. Swearingen B, Barker FG, II, Katznelson L, et al. Long-term mortality after transsphenoidal surgery and adjunctive therapy for acromegaly. J Clin Endocrinol Metab 1998;83:3419–26.

    Article  PubMed  CAS  Google Scholar 

  4. Bates AS, Van’t Hoff W, Jones JM, Clayton RN. An audit of outcome of treatment in acromegaly. Q J Med 1993;86:293–9.

    Google Scholar 

  5. Giustina A, Barkan A, Casanueva FF, et al. Criteria for cure of acromegaly: a consensus statement. J Clin Endocrinol Metab 2000;85:526–9.

    Article  PubMed  CAS  Google Scholar 

  6. Bonadonna S, Doga M, Gola M, Mazziotti G, Giustina A. Diagnosis and treatment of acromegaly and its complications: consensus guidelines. J Endocrinol Invest 2005;28:43–7.

    PubMed  CAS  Google Scholar 

  7. Melmed S, Casanueva F, Cavagnini F, et al. Consensus statement: medical management of acromegaly. Eur J Endocrinol 2005;153:737–40.

    Article  PubMed  CAS  Google Scholar 

  8. Colao A, Attanasio R, Pivonello R, et al. Partial surgical removal of growth hormone-secreting pituitary tumors enhances the response to somatostatin analogs in acromegaly. J Clin Endocrinol Metab 2006;91:85–92.

    Article  PubMed  CAS  Google Scholar 

  9. Buchfelder M, Fahlbusch R. The “classic” transsphenoidal approach for resection of pituitary tumors. Operat Techn Neurosurg 2002;4:210–17.

    Article  Google Scholar 

  10. Couldwell WT. Transsphenoidal and transcranial surgery for pituitary adenomas. J Neurooncol 2004;69:237–56.

    Article  PubMed  Google Scholar 

  11. Ross DA, Wilson CB. Results of transsphenoidal microsurgery for growth hormone-secreting pituitary adenoma in a series of 214 patients. J Neurosurg 1988;68:854–67.

    PubMed  CAS  Google Scholar 

  12. Zervas NT. Multicenter surgical results in acromegaly. In: Ludecke D, Tolis G, editors. Growth Hormone, Growth Factors, and Acromegaly. New York: Raven Press; 1987. pp. 253–7.

    Google Scholar 

  13. Fahlbusch R, Honegger J, Buchfelder M. Surgical management of acromegaly. Endocrinol Metab Clin North Am 1992;21:669–92.

    PubMed  CAS  Google Scholar 

  14. Losa M, Oeckler R, Schopohl J, Muller OA, Alba-Lopez J, von Werder K. Evaluation of selective transsphenoidal adenomectomy by endocrinological testing and somatomedin-C measurement in acromegaly. J Neurosurg 1989;70:561–7.

    PubMed  CAS  Google Scholar 

  15. Valdemarsson S, Bramnert M, Cronquist S, et al. Early postoperative basal serum GH level and the GH response to TRH in relation to the long-term outcome of surgical treatment for acromegaly: a report on 39 patients. J Intern Med 1991;230:49–54.

    Article  PubMed  CAS  Google Scholar 

  16. Valdemarsson S, Ljunggren S, Bramnert M, Norrhamn O, Nordstrom CH. Early postoperative growth hormone levels: high predictive value for long-term outcome after surgery for acromegaly. J Intern Med 2000;247:640–50.

    Article  PubMed  CAS  Google Scholar 

  17. Tindall GT, Oyesiku NM, Watts NB, Clark RV, Christy JH, Adams DA. Transsphenoidal adenomectomy for growth hormone-secreting pituitary adenomas in acromegaly: outcome analysis and determinants of failure. J Neurosurg 1993;78:205–15.

    PubMed  CAS  Google Scholar 

  18. Laws ER, Vance ML, Thapar K. Pituitary surgery for the management of acromegaly. Horm Res 2000;53:71–5.

    Article  PubMed  CAS  Google Scholar 

  19. Kreutzer J, Vance ML, Lopes MB, Laws ER, Jr. Surgical management of GH-secreting pituitary adenomas: an outcome study using modern remission criteria. J Clin Endocrinol Metab 2001;86:4072–7.

    Article  PubMed  CAS  Google Scholar 

  20. Nomikos P, Buchfelder M, Fahlbusch R. The outcome of surgery in 668 patients with acromegaly using current criteria of biochemical “cure.” Eur J Endocrinol 2005;152: 379–87.

    Article  PubMed  CAS  Google Scholar 

  21. Peacey SR, Toogood AA, Veldhuis JD, Thorner MO, Shalet SM. The relationship between 24-hour growth hormone secretion and insulin- like growth factor I in patients with successfully treated acromegaly: impact of surgery or radiotherapy. J Clin Endocrinol Metab 2001;86:259–66.

    Article  PubMed  CAS  Google Scholar 

  22. Morrison KM, Wu Z, Bidlingmaier M, Strasburger CJ. Findings and theoretical considerations on the usefulness of the acid-labile subunit in the monitoring of acromegaly. Growth Horm IGF Res 2001;11(Suppl A):S61–3.

    Google Scholar 

  23. Hardy J. Transsphenoidal microsurgery of the pathological and normal pituitary. Clin Neurosurg 1969;16:185–217.

    PubMed  CAS  Google Scholar 

  24. Kaltsas GA, Nomikos P, Kontogeorgos G, Buchfelder M, Grossman AB. Clinical review: Diagnosis and management of pituitary carcinomas. J Clin Endocrinol Metab 2005;90:3089–99.

    Article  PubMed  CAS  Google Scholar 

  25. Ahmadi J, North CM, Segall HD, Zee CS, Weiss MH. Cavernous sinus invasion by pituitary adenomas. AJR Am J Roentgenol 1986;146:257–62.

    PubMed  CAS  Google Scholar 

  26. Buchfelder M, Fahlbusch R, Adams EF, Kiesewetter F, Thierauf P. Proliferation parameters for pituitary adenomas. Acta Neurochir Suppl 1996;65:18–21.

    PubMed  CAS  Google Scholar 

  27. Sheaves R, Jenkins P, Blackburn P, et al. Outcome of transsphenoidal surgery for acromegaly using strict criteria for surgical cure. Clin Endocrinol (Oxf) 1996;45:407–13.

    Article  CAS  Google Scholar 

  28. Colao A, Ferone D, Cappabianca P, et al. Effect of octreotide pretreatment on surgical outcome in acromegaly. J Clin Endocrinol Metab 1997;82:3308–14.

    Article  PubMed  CAS  Google Scholar 

  29. Kristof RA, Stoffel-Wagner B, Klingmuller D, Schramm J. Does octreotide treatment improve the surgical results of macro- adenomas in acromegaly? A randomized study. Acta Neurochir 1999;141:399–405.

    Article  CAS  Google Scholar 

  30. Plockinger U, Quabbe HJ. Presurgical octreotide treatment in acromegaly: no improvement of final growth hormone (GH) concentration and pituitary function. A long-term case-control study. Acta Neurochir (Wien) 2005;147:485–93; discussion 493.

    Article  CAS  Google Scholar 

  31. Ahmed S, Elsheikh M, Stratton IM, Page RC, Adams CB, Wass JA. Outcome of transsphenoidal surgery for acromegaly and its relationship to surgical experience. Clin Endocrinol (Oxf) 1999;50:561–7.

    Article  CAS  Google Scholar 

  32. Clayton RN, Stewart PM, Shalet SM, Wass JA. Pituitary surgery for acromegaly. Should be done by specialists. BMJ 1999;319:588–9.

    PubMed  CAS  Google Scholar 

  33. Barker FG, II, Klibanski A, Swearingen B. Transsphenoidal surgery for pituitary tumors in the United States, 1996–2000: mortality, morbidity, and the effects of hospital and surgeon volume. J Clin Endocrinol Metab 2003;88:4709–19.

    Article  PubMed  CAS  Google Scholar 

  34. Schmitt H, Buchfelder M, Radespiel-Troger M, Fahlbusch R. Difficult intubation in acromegalic patients: incidence and predictability. Anesthesiology 2000;93:110–14.

    Article  PubMed  CAS  Google Scholar 

  35. Buchfelder M, Brockmeier S, Fahlbusch R, Honegger J, Pichl J, Manzl M. Recurrence following transsphenoidal surgery for acromegaly. Horm Res 1991;35:113–18.

    PubMed  CAS  Google Scholar 

  36. Arafah BM, Rosenzweig JL, Fenstermaker R, Salazar R, McBride CE, Selman W. Value of growth hormone dynamics and somatomedin C (insulin-like growth factor I) levels in predicting the long-term benefit after transsphenoidal surgery for acromegaly. J Lab Clin Med 1987;109:346–54.

    PubMed  CAS  Google Scholar 

  37. Ronchi CL, Varca V, Giavoli C, et al. Long-term evaluation of postoperative acromegalic patients in remission with previous and newly proposed criteria. J Clin Endocrinol Metab 2005;90:1377–82.

    Article  PubMed  CAS  Google Scholar 

  38. Beauregard C, Truong U, Hardy J, Serri O. Long-term outcome and mortality after transsphenoidal adenomectomy for acromegaly. Clin Endocrinol (Oxf) 2003;58:86–91.

    Article  Google Scholar 

  39. Davis DH, Laws ER, Jr, Ilstrup DM, et al. Results of surgical treatment for growth hormone-secreting pituitary adenomas. J Neurosurg 1993;79:70–5.

    PubMed  CAS  Google Scholar 

  40. Biermasz NR, van Dulken H, Roelfsema F. Ten-year follow-up results of transsphenoidal microsurgery in acromegaly. J Clin Endocrinol Metab 2000;85:4596–602.

    Article  PubMed  CAS  Google Scholar 

  41. Zirkzee EJ, Corssmit EP, Biermasz NR, et al. Pituitary magnetic resonance imaging is not required in the postoperative follow-up of acromegalic patients with long-term biochemical cure after transsphenoidal surgery. J Clin Endocrinol Metab 2004;89:4320–4.

    Article  PubMed  CAS  Google Scholar 

  42. Freda PU, Post KD, Powell JS, Wardlaw SL. Evaluation of disease status with sensitive measures of growth hormone secretion in 60 postoperative patients with acromegaly. J Clin Endocrinol Metab 1998;83:3808–16.

    Article  PubMed  CAS  Google Scholar 

  43. Freda PU, Nuruzzaman AT, Reyes CM, et al. Significance of “abnormal” nadir growth hormone levels after oral glucose in postoperative patients with acromegaly in remission with normal insulin-like growth factor-I levels. J Clin Endocrinol Metab 2004;89:495–500.

    Article  PubMed  CAS  Google Scholar 

  44. Biermasz NR, Smit JW, van Dulken H, Roelfsema F. Postoperative persistent thyrotrophin releasing hormone-induced growth hormone release predicts recurrence in patients with acromegaly. Clin Endocrinol (Oxf) 2002;56:313–9.

    Article  CAS  Google Scholar 

  45. Long H, Beauregard H, Somma M, Comtois R, Serri O, Hardy J. Surgical outcome after repeated transsphenoidal surgery in acromegaly. J Neurosurg 1996;85:239–47.

    PubMed  CAS  Google Scholar 

  46. Kurosaki M, Luedecke DK, Abe T. Effectiveness of secondary transnasal surgery in GH-secreting pituitary macroadenomas. Endocr J 2003;50:635–42.

    Article  PubMed  Google Scholar 

  47. Abe T, Ludecke DK. Recent results of secondary transnasal surgery for residual or recurring acromegaly. Neurosurgery 1998;42:1013–21; discussion 1021–2.

    Article  PubMed  CAS  Google Scholar 

  48. Fahlbusch R. Future avenues in treatment of pituitary adenomas. Pituitary 1999;2:113–15.

    Article  PubMed  CAS  Google Scholar 

  49. Abe T, Ludecke DK. Recent primary transnasal surgical outcomes associated with intraoperative growth hormone measurement in acromegaly. Clin Endocrinol (Oxf) 1999;50: 27–35.

    Article  CAS  Google Scholar 

  50. Buchfelder M. Treatment of pituitary tumors: surgery. Endocrine 2005;28:67–75.

    Article  PubMed  CAS  Google Scholar 

  51. Fahlbusch R, Ganslandt O, Buchfelder M, Schott W, Nimsky C. Intraoperative magnetic resonance imaging during transsphenoidal surgery. J Neurosurg 2001;95:381–90.

    PubMed  CAS  Google Scholar 

  52. Fahlbusch R, Keller B, Ganslandt O, Kreutzer J, Nimsky C. Transsphenoidal surgery in acromegaly investigated by intraoperative high-field magnetic resonance imaging. Eur J Endocrinol 2005;153:239–48.

    Article  PubMed  CAS  Google Scholar 

  53. Abosch A, Tyrrell JB, Lamborn KR, Hannegan LT, Applebury CB, Wilson CB. Transsphenoidal microsurgery for growth hormone-secreting pituitary adenomas: initial outcome and long-term results. J Clin Endocrinol Metab 1998;83:3411–18.

    Google Scholar 

  54. Freda PU, Wardlaw SL, Post KD. Long-term endocrinological follow-up evaluation in 115 patients who underwent transsphenoidal surgery for acromegaly. J Neurosurg 1998;89: 353–8.

    PubMed  CAS  Google Scholar 

  55. De P, Rees DA, Davies N, et al. Transsphenoidal surgery for acromegaly in Wales: results based on stringent criteria of remission. J Clin Endocrinol Metab 2003;88:3567–72.

    Google Scholar 

Download references

Authors
  1. Michael Buchfelder MD PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Panagiotis Nomikos MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Department of Neurosurgery Massachusetts, General Hospital Harvard Medical School, Boston, MA, USA

    Brooke Swearingen MD

  2. Neuroendocrine Unit Department of Medicine, Massachusetts General Hospital Harvard Medical School, Boston, MA, USA

    Beverly M. K. Biller MD

Rights and permissions

Reprints and permissions

Copyright information

© 2008 Humana Press, Totowa, NJ

About this chapter

Cite this chapter

Buchfelder, M., Nomikos, P. (2008). Acromegaly: Surgical Management . In: Swearingen, B., Biller, B.M. (eds) Diagnosis and Management of Pituitary Disorders. Contemporary Endocrinology. Humana Press. https://doi.org/10.1007/978-1-59745-264-9_9

Download citation

  • DOI: https://doi.org/10.1007/978-1-59745-264-9_9

  • Publisher Name: Humana Press

  • Print ISBN: 978-1-58829-922-2

  • Online ISBN: 978-1-59745-264-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation