Pituitary surgery for acromegaly

The objective of treatment in acromegaly is not only to alleviate symptoms, improve quality of life, and prevent complications but also to reverse the increased (two to threefold) mortality from vascular and respiratory disease and colon cancer. That this can be achieved if “target” basal growth hormone concentrations of <5 mU/l (2.5 ng/ml) are reached has been shown,1 2 with the proviso that serum insulin-like growth factor 1 (IGF-1) values may need to be reduced to the normal age-related reference range.3 Transsphenoidal adenomectomy is the most rapid means of reducing serum growth hormone and IGF-1 in acromegaly. The question then arises of how effective surgery is at achieving the target growth hormone and IGF-1 values. Subsidiary issues are: ( a ) what determines the outcome of surgery? ( b ) what is the relapserate? ( c ) what is the complication rate? and ( d ) what is the most cost effective service provision? Surgical outcomes in terms of safe target growth hormone concentrations have recently been reported …