Management of acromegaly beyond primary surgery: efficacy and safety of repeat surgery and radiotherapy

Introduction and purpose Re-intervention, either transsphenoidal surgery or radiotherapy, is suggested in patients who are not in remission after primary surgery for acromegaly; however, the evidence is weak. We aimed to assess the remission rate after re-intervention, and complications compared to a comparison group who had undergone primary interventions only. Methods Patients diagnosed with acromegaly between 2005–2021 at Oslo University Hospital were screened for inclusion. The study cohort included patients with two or more interventions. The comparison group included patients not in remission after primary surgery. Results Of 223 patients with acromegaly, 42 underwent re-interventions (study cohort). At diagnosis, median age was 38 (IQR 29–48) years and 41 patients (98%) had a macroadenoma. The comparison group consisted of 49 patients, median age 54 (IQR 44–60) years and 37 (76%) had a macroadenoma at diagnosis. Re-interventions in the study cohort consisted of surgery, radiotherapy and a combination of these (22, 12 and eight patients). After re-interventions, 22 patients (52%) were in remission and 12 (29%) had reduced disease activity. Seven patients (17%) acquired new hormone deficiencies, two of them corticotroph deficiency. One patient in remission developed spinal fluid leakage and meningitis. There was no significant difference in complications after surgery between the study cohort and the comparison group. Conclusion Re-interventions were safe and resulted in remission or substantial improvement in most patients. Re-intervention should be considered for patients who would otherwise require lifelong medical treatment.