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International Journal of Endocrinology
Volume 2012 (2012), Article ID 306094, 13 pages
http://dx.doi.org/10.1155/2012/306094
Review Article

Acromegaly: Role of Surgery in the Therapeutic Armamentarium

1Department of Neurosurgery, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, 06720 Mexico City, DF, Mexico
2Centro Neurológico ABC, 05300 Mexico City, DF, Mexico
3Department of Neurology, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, 06720 Mexico City, DF, Mexico
4Department of Endocrinology, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, 06720 Mexico City, DF, Mexico

Received 31 May 2012; Accepted 19 August 2012

Academic Editor: Chiung-Chyi Shen

Copyright © 2012 Gerardo Guinto et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Acromegaly is a complex disease that requires the intervention of a multidisciplinary team. The most frequent clinical manifestations are growing of distal parts of the body and some areas of the face. Patients may also present arterial hypertension, diabetes mellitus, colonic polyps, cardiomegaly, neurological and endocrine changes secondary to the presence of a GH-secreting tumor in pituitary or extrapituitary origin, or eutopic hypothalamic GHRH hypersecretion and peripheral GHRH hypersecretion. Surgery is the first treatment used for most patients, regardless of the cause. In the great majority of cases, pituitary tumor can be removed through a transsphenoidal approach. Craniotomy is reserved for those cases with giant tumors, particularly when they grow toward the middle or posterior cranial fossa. Best surgical results are obtained when the tumor is confined into the sella turcica or if it has a regular suprasellar extension. When the disease cannot be controlled with surgery, medical treatment is indicated. Somatostatin analogues are included as the first line of medication, followed by dopamine agonist and growth hormone receptors antagonists. Radiation therapy can be also indicated in two main forms for residual tumor with medically refractory patients: radiosurgery for small tumors or fractionated stereotactic radiotherapy for larger ones.