Surgery is the first treatment used for most people with excess growth hormone, regardless of the cause. Surgery brings about remission in some people, but not in all. People who are in remission after surgery usually need no further treatment.
- The operation of choice for pituitary adenoma is transsphenoidal hypophysectomy. The tumor is removed via one of the nasal sinuses through an incision inside the nose.
- If it is successful, this operation has 2 advantages. It rapidly improves symptoms caused by the tumor pressing on adjacent tissue, and it normalizes levels of growth hormone and IGF-I.
- While this operation technically is not brain surgery, it requires a great deal of care to avoid injuring delicate tissues surrounding the pituitary. Success depends largely on the skill and experience of the surgeon.
- Remission rates are about 80-85% for small adenomas (microadenomas) and 50-65% for large adenomas (macroadenomas).
- The growth hormone and IGF-1 levels after surgery usually indicate whether further treatment is needed.
- Some people require lifelong hormone replacement after pituitary surgery.
Hasnain M Khandwala, MD, FRCPC
Arthur B Chausmer, MD, PhD, FACP, FACE, FACN, CNS
Francisco Talavera, PharmD, PhD
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