ACROMEGALY

Taming Goliath: A surgical revolution in acromegaly treatment

OVERVIEW

Acromegaly is a hormonal disorder in which the pituitary gland produces too much growth hormone. This disorder causes abnormal enlargement of bones and tissues, noticeably in the hands and feet, which occurs gradually over several years.
Enlarged bones in the nose and mouth may cause a large tongue and widely spaced teeth and may lead to sleep apnea. Bone and cartilage growth may lead to arthritis. People with acromegaly can also develop diabetes, high blood pressure, and other problems.
The onset of acromegaly is insidious and seemingly benign, so the signs and symptoms are often ignored or are associated with other more common causes.
By the time an acromegaly patient sees an endocrinologist for diagnosis and treatment, the signs and symptoms have already become very distressing and in some cases permanent. Acromegaly may also lead to a risk of premature mortality.
Early diagnosis and appropriate therapy may lead to reversal and/or prevention of these long-term consequences.

INNOVATION IN SURGICAL TECHNIQUE

Growth-hormone secreting adenomas often invade the medial wall of the cavernous sinus, but this structure is generally not surgically removed because of the risk of vascular and cranial nerve injury. This results on incomplete tumor resections and persistent disease in many patients, with need for long-term medical treatment and/or radiotherapy.
Over the last decade I have meticulously investigated the medial wall of the cavernous sinus introducing a classification of the parasellar ligaments and their role in anchoring the medial wall, and have developed an innovative technique for selective resection of the medial wall when invaded by tumor.
This pioneering technique has been applied to over 150 patients with all types of pituitary tumors with minimal morbidity and excellent resection and remission rates.

BEST SURGICAL RESULTS EVER REPORTED

The success of surgery for acromegaly is defined by normalization of IGF-1 levels 3 to 6 months after surgery. Multiple surgical series from experienced centers, included ours in 2014, have reported surgical remission rates to vary between 50%-60%. However, after the introduction of the technique for surgical resection of the medial wall of cavernous sinus, the remission rates in the last 30 consecutive patients have improved to over 90%. Even patients with residual tumor after surgery at another center have benefited from the innovative surgical technique achieving surgical remission after a previous unsuccessful surgery. No patients have suffered injury to the carotid artery or permanent double vision, and the need for medical treatment or radiotherapy after surgery has been greatly reduced.