Part of “CHAPTER 21 – MEDICAL TREATMENT OF PITUITARY TUMORS AND HYPERSECRETORY STATES“

Transsphenoidal surgery remains the treatment of choice for growth hormone–secreting adenomas (see Chap. 23). The overall rate of cure (defined as serum growth hormone levels of <5 ng/mL) is ˜68% (88% of microadenomas and 59% of macroadenomas).38 Approximately 75% of patients who undergo conventional radiation therapy eventually achieve normalization of serum growth hormone levels over several years (see Chap. 22). The cure rate with proton beam irradiation of tumors without extrasellar extension approaches 95%. Medical therapy has generally been reserved for those patients who refuse surgery or radiation therapy or in whom these treatment modalities have been unsuccessful as well as for those patients awaiting the full effects of irradiation. Pretreatment with somatostatin analogs may improve surgical outcomes.39 In patients with acromegaly secondary to paraneoplastic (“ectopic”) growth hormone–releasing hormone secretion (see Chap. 12 and Chap. 219), removal of the tumor secreting growth hormone–releasing hormone is the treatment of choice. If this is impossible, medical treatment may be indicated.