Abstract
This paper presents an overview of the evolution of pituitary surgery for acromegaly. It begins with the first case, attempted in 1893, through the initial transsphenoidal successes in 1907–1910, to the development of effective craniotomy approaches, and ultimately to the resurrection of the transsphenoidal approach in the 1970s and thereafter. Today, the minimally endoscopic transnasal endoscopic approach is fast becoming the norm. Indications for surgery include active acromegaly, visual loss and other forms of mass effect, pituitary tumor apoplexy, and failure of other therapies (medical, radiation). Contraindications include advanced age, debility or other medical conditions increasing the risk of general anaesthesia or surgery. Surgery for acromegaly has the advantage of immediate lowering of the growth hormone excess, with endocrine remission rates of 70% for microadenomas and 50% for macroadenomas. When surgery fails to obtain remission, a program of therapy is designed for the patient to include adjunctive medical therapy (dopamine agonists, somatostatin analogs, and growth hormone receptor antagonists), radiation therapy or radiosurgery (Gamma knife, Cyberknife, etc.).
Similar content being viewed by others
References
Attanasio R, Epaminonda P, Motti E, Giugni E, Ventrella L, Cozzi R, et al. Gamma-knife radiosurgery in acromegaly: a 4-year follow-up study. J Clin Endocrinol Metab. 2003;88:3105–12.
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.
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.
Caton R, Paul FT. Notes of a case of acromegaly treated by operation. Br Med J. 1893;2:1421–3.
Cohen-Gadol AA, Laws ER, Spencer DD, De Salles AA. The evolution of Harvey Cushing's surgical approach to pituitary tumors from transsphenoidal to transfrontal. J Neurosurg. 2005;103:372–7.
Cushing H. Partial hypophysectomy for acromegaly: with remarks on the function of the hypophysis. Ann Surg. 1909;50:1002–7.
De P, Rees DA, Davies N, John R, Neal J, Mills RG, et al. Transsphenoidal surgery for acromegaly in Wales: results based on stringent criteria of remission. J Clin Endocrinol Metab. 2003;88:3567–72.
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.
Guiot G, Derome P, Wislawski J. Neurosurgical problems and criteria of therapeutic efficiency in acromegaly. Neurochirurgie. 1971;17:5–10.
Hardy J. Microadenectomy or microhypophysectomy. J Neurosurg. 1978;48:668.
Hardy J. The transsphenoidal surgical approach to the pituitary. Hosp Pract. 1979;14:81–9.
Hardy J, Vezina JL. Transsphenoidal neurosurgery of intracranial neoplasm. Adv Neurol. 1976;15:261–73.
Hirsch O. Endonasal method of operation on pituitary tumors; report of two cases. Arch Neurol Psychiatry. 1950;63:158–62.
Hirsch O. Pituitary tumors; a borderland between cranial and trans-sphenoidal surgery. N Engl J Med. 1956;254:937–9.
Horsley V. On the technique of operations on the central nervous system. Br Med J. 1906;2:411–23.
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.
Roberts BK, Ouyang DL, Lad SP, Chang SD, Harsh GRT, Adler JR Jr., et al. Efficacy and safety of CyberKnife radiosurgery for acromegaly. Pituitary. 2007;10:19–25.
Schloffer H. Erfolgreiche Operation eines Hypophysentumors auf nasalem wege. Wein Klin Wochenschr. 1907;20:621–4.
Schloffer H. Zur Frage der Operationen an der Hypophyse. Beitr Klin Chir. 1906;50:767–817.
Swearingen B, Barker FG 2nd, Katznelson L, Biller BM, Grinspoon S, Klibanski A, et al. Long-term mortality after transsphenoidal surgery and adjunctive therapy for acromegaly. J Clin Endocrinol Metab. 1998;83:3419–26.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Laws, E.R. Surgery for acromegaly: Evolution of the techniques and outcomes. Rev Endocr Metab Disord 9, 67–70 (2008). https://doi.org/10.1007/s11154-007-9064-y
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11154-007-9064-y