eMedicine Specialties > Endocrinology > Pituitary Gland

Acromegaly: Follow-up

Author: Hasnain M Khandwala, MD, FRCPC, Endocrinologist, LMC Endocrinology Centers, Canada
Contributor Information and Disclosures

Updated: Feb 13, 2009

Follow-up

Inpatient & Outpatient Medications

See Medication.

Prognosis

  • Remission depends on the initial size of the tumor, the GH level, and the skill of the neurosurgeon.
    • Remission rates of 80-85% and 50-65% can be expected for microadenomas and macroadenomas, respectively.
    • The postoperative GH concentration may predict remission rates. According to the results of one study, a postoperative GH concentration of less than 3 ng/dL was associated with a 90% remission rate, which declined to 5% in patients with a postoperative GH concentration greater than 5 ng/dL.

Patient Education

For excellent patient education resources, visit eMedicine's Acromegaly Center. Also, see eMedicine's patient education articles Acromegaly, Acromegaly FAQs, and Understanding Acromegaly Medications.

Miscellaneous

Medicolegal Pitfalls

Acromegaly is unusual, with a new case incidence of 3-4 per million subjects per year and a mean age of 40-45 years. Acromegaly can be an insidious disease, and symptoms might precede diagnosis by several years; therefore, failure to recognize the disease early in its course is the major medicolegal pitfall.

 


More on Acromegaly

Overview: Acromegaly
Differential Diagnoses & Workup: Acromegaly
Treatment & Medication: Acromegaly
Follow-up: Acromegaly
References
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References

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  2. Bates AS, Van't Hoff W, Jones JM, et al. An audit of outcome of treatment in acromegaly. Q J Med. May 1993;86(5):293-9. [Medline].

  3. Ezzat S. Acromegaly. Endocrinol Metab Clin North Am. Dec 1997;26(4):703-23. [Medline].

  4. Feenstra J, de Herder WW, ten Have SM, et al. Combined therapy with somatostatin analogues and weekly pegvisomant in active acromegaly. Lancet. May 7-13 2005;365(9471):1644-6. [Medline].

  5. Freda PU. Current concepts in the biochemical assessment of the patient with acromegaly. Growth Horm IGF Res. Aug 2003;13(4):171-84. [Medline].

  6. Freda PU, Wardlaw SL, Post KD. Long-term endocrinological follow-up evaluation in 115 patients who underwent transsphenoidal surgery for acromegaly. J Neurosurg. Sep 1998;89(3):353-8. [Medline].

  7. Gagel RF, McCutcheon IE. Images in clinical medicine. Pituitary gigantism. N Engl J Med. Feb 18 1999;340(7):524. [Medline].

  8. McCutcheon IE. Management of individual tumor syndromes. Pituitary neoplasia. Endocrinol Metab Clin North Am. Mar 1994;23(1):37-51. [Medline].

  9. Melmed S, Ho K, Klibanski A, et al. Clinical review 75: Recent advances in pathogenesis, diagnosis, and management of acromegaly. J Clin Endocrinol Metab. Dec 1995;80(12):3395-402. [Medline].

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  11. Newman CB. Medical therapy for acromegaly. Endocrinol Metab Clin North Am. Mar 1999;28(1):171-90. [Medline].

  12. Newman CB, Melmed S, George A, et al. Octreotide as primary therapy for acromegaly. J Clin Endocrinol Metab. Sep 1998;83(9):3034-40. [Medline].

  13. Paisley AN, Trainer PJ. Medical treatment in acromegaly. Curr Opin Pharmacol. Dec 2003;3(6):672-7. [Medline].

  14. Rajasoorya C, Holdaway IM, Wrightson P, et al. Determinants of clinical outcome and survival in acromegaly. Clin Endocrinol (Oxf). Jul 1994;41(1):95-102. [Medline].

  15. Spada A, Vallar L. G-protein oncogenes in acromegaly. Horm Res. 1992;38(1-2):90-3. [Medline].

  16. Thorner M, Vance ML, Laws E. The anterior pituitary. In: Wilson JD, ed. Williams Textbook of Endocrinology. 9th ed. Philadelphia, Pa: Saunders; 1998:249-340.

  17. Trainer PJ, Drake WM, Katznelson L, et al. Treatment of acromegaly with the growth hormone-receptor antagonist pegvisomant. N Engl J Med. Apr 20 2000;342(16):1171-7. [Medline].

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Further Reading

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Keywords

growth hormone, GH, somatotroph tumor, growth hormone-releasing hormone, GHRH, insulinlike growth factor-I, IGF-I, somatomedin C, SM-C, guanosine triphosphate, GTP, glycogen synthetase phosphatase, GSP, acral overgrowth, macrognathia, visceral overgrowth, macroglossia, panhypopituitarism, somatic hypertrophy, hypertrophic arthropathy, kyphosis, hyperhidrosis, visceral hypersomia, multinodular goiter, colon polyposis, pseudoacromegaly, transsphenoidal hypophysectomy, somatostatin analogues, dopamine agonists, immunoradiometric assay, IRMA

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Contributor Information and Disclosures

Author

Hasnain M Khandwala, MD, FRCPC, Endocrinologist, LMC Endocrinology Centers, Canada
Hasnain M Khandwala, MD, FRCPC is a member of the following medical societies: American Association of Clinical Endocrinologists, American College of Physicians, American Diabetes Association, Canadian Medical Association, and Endocrine Society
Disclosure: Nothing to disclose.

Medical Editor

Barry J Goldstein, MD, PhD, Director, Division of Endocrinology, Diabetes and Metabolic Diseases, Professor, Department of Internal Medicine, Thomas Jefferson University
Barry J Goldstein, MD, PhD is a member of the following medical societies: Alpha Omega Alpha, American College of Clinical Endocrinologists, American College of Physicians-American Society of Internal Medicine, American Diabetes Association, and Endocrine Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Arthur B Chausmer, MD, PhD, FACP, FACE, FACN, CNS, Professor of Medicine (Endocrinology, Adj), Johns Hopkins School of Medicine; Affiliate Research Professor, Bioinformatics and Computational Biology Program, School of Computational Sciences, George Mason University; Principal, C/A Informatics, LLC
Arthur B Chausmer, MD, PhD, FACP, FACE, FACN, CNS is a member of the following medical societies: American Association of Clinical Endocrinologists, American College of Endocrinology, American College of Nutrition, American College of Physician Executives, American College of Physicians, American College of Physicians-American Society of Internal Medicine, American Medical Informatics Association, American Society for Bone and Mineral Research, American Society of Law Medicine and Ethics, Endocrine Society, and International Society for Clinical Densitometry
Disclosure: Nothing to disclose.

CME Editor

Mark Cooper, MBBS, PhD, FRACP, Head, Diabetes & Metabolism Division, Baker Heart Research Institute, Professor of Medicine, Monash University
Disclosure: Nothing to disclose.

Chief Editor

George T Griffing, MD, Professor of Medicine, St Louis University School of Medicine
George T Griffing, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Medical Practice Executives, American College of Physician Executives, American College of Physicians, American Diabetes Association, American Federation for Medical Research, American Heart Association, Central Society for Clinical Research, Endocrine Society, International Society for Clinical Densitometry, and Southern Society for Clinical Investigation
Disclosure: Nothing to disclose.

 
 
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