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Seminars in Neurosurgery 2001; 12(3): 295-304
DOI: 10.1055/s-2001-33620
Copyright © 2002 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Management of Growth Hormone-Secreting Adenomas: An Update

Nelson M. Oyesiku
  • Department of Neurosurgery, Emory Univerity School of Medicine, Atlanta, Georgia
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Publication History

Publication Date:
27 August 2002 (online)

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ABSTRACT

Acromegaly is a chronic, debilitating condition caused by excessive secretion of growth hormone (GH). The average incidence of acromegaly is approximately 3.3 per million each year with a prevalence of approximately 60 per million.[1] [2] GH-secreting adenomas account for 20% of functional adenomas; 75% of GH adenomas are macroadenomas. In the majority of cases, the condition results from benign pituitary adenomas or, rarely, from ectopic production of GH-releasing hormone (GHRH). Ectopic production of GHRH may be from carcinoid, islet cell, and other tumors and may be identified histologically by hyperplasia of somatotrophs or biochemically by elevated circulating levels of GHRH. Excessive GH results in phenotypic changes including acral enlargement, soft tissue swelling, and facial coarsening. Other features include sweating, menstrual irregularity, headache, arthritis, carpal tunnel syndrome, diabetes, hypertension, cardiac dysfunction, loss of libido, galactorrhea, visual field defects, obstructive sleep apnea, and colonic neoplasia.[1] [3] [4] [5] [6] [7] The mortality for acromegalic patients is two to three times higher than that of the general population, but with appropriate reduction of GH hypersecretion, it tends to shift into the normal range.[8] Treatment is directed to normalizing GH secretion, eradicating or stabilizing the pituitary tumor, preserving normal pituitary function, and managing any associated complications of GH hypersecretion. The treatment modalities available include transsphenoidal surgery, pharmacotherapy, and radiation or combination therapy. This article provides an update of the pathophysiology of GH hypersecretion in acromegaly, the newly defined diagnostic criteria and the end point for a cure for acromegaly, and new developments in pharmacotherapy and radiotherapy.

KEYWORDS

Acromegaly - pituitary adenoma - transsphenoidal surgery

REFERENCES

  • 1 Melmed S, Ho K, Klibanski A, Reichlin S, Thorner M. Clinical review 75: recent advances in pathogenesis, diagnosis, and management of acromegaly.  J Clin Endocrinol Metab . 1995;  80 3395-3402
    CrossrefPubMedSearch in Google Scholar
  • 2 Colao A, Merola B, Ferone D, Lombardi G. Acromegaly.  J Clin Endocrinol Metabol . 1997;  82 2777-2781
    CrossrefPubMedSearch in Google Scholar
  • 3 Melmed S. Acromegaly.  N Engl J Med . 1990;  322 966-977
    CrossrefPubMedSearch in Google Scholar
  • 4 Wass J A. Acromegaly: treatment after 100 years.  Br Med J . 1993;  307 1505-1506
    PubMedSearch in Google Scholar
  • 5 Barkan A L. Acromegaly. Diagnosis and therapy.  Endocrinol Metab Clin North Am . 1989;  18 277-310
    PubMedSearch in Google Scholar
  • 6 Molitch M E. Clinical manifestations of acromegaly.  Endocrinol Metabol Clin North Am . 1992;  21 597-614
    PubMedSearch in Google Scholar
  • 7 Ezzat S, Wilkins G E, Patel Y, Ur E, Rorstad O, Serri O. The diagnosis and management of acromegaly: a Canadian consensus report.  Clin Invest Med-Medecine Clinique et Experimentale . 1996;  19 259-270
    PubMedSearch in Google Scholar
  • 8 Melmed S, Jackson I, Kleinberg D, Klibanski A. Current treatment guidelines for acromegaly.  J Clin Endocrinol Metabol . 1998;  83 2646-2652
    CrossrefPubMedSearch in Google Scholar
  • 9 Melmed S. Acromegaly.  Metabolism . 1996;  S51-S52
    PubMedSearch in Google Scholar
  • 10 Alster D K, Bowers C Y, Jaffe C A, Ho P J, Barkan A L. The growth hormone (GH) response to GH-releasing peptide (His-DTrp-Ala-Trp-DPhe Lys-NH2), GH-releasing hormone, and thyrotropin-releasing hormone in acromegaly.  J Clin Endocrinol Metabol . 1993;  77 842-845
    CrossrefPubMedSearch in Google Scholar
  • 11 Bertherat J, Bluet-Pajot M T, Epelbaum J. Neuroendocrine regulation of growth hormone.  Eur J Endocrinol . 1995;  132 12-24
    PubMedSearch in Google Scholar
  • 12 Sassolas G. Growth hormone-releasing hormone: past and present.  Horm Res . 2000;  S88-S92
    PubMedSearch in Google Scholar
  • 13 Massara F, Porzio G, Camanni F, Molinatti G M. The effect of somatostatin on plasma insulin and growth hormone levels in basal conditions and after glucagon in normal and acromegalic subjects.  Acta Diabetol . 1975;  12 219-231
    PubMedSearch in Google Scholar
  • 14 Reichlin S. Secretion of somatostatin and its physiologic function.  J Lab Clin Med . 1987;  109 320-326
    PubMedSearch in Google Scholar
  • 15 Scarpignato C, Pelosini I. Somatostatin analogs for cancer treatment and diagnosis: an overview.  Chemotherapy . 2001;  1-29
    PubMedSearch in Google Scholar
  • 16 Chen H S, Lin H D. Serum IGF-I and IGFBP-3 levels for the assessment of disease activity of acromegaly.  J Endocrinol Invest . 1999;  22 98-103
    PubMedSearch in Google Scholar
  • 17 Collett-Solberg P F, Cohen P. Genetics, chemistry, and function of the IGF/IGFBP system.  Endocr J (UK) . 2000;  12 121-136
    CrossrefPubMedSearch in Google Scholar
  • 18 Peacey S R, Shalet S M. Insulin-like growth factor 1 measurement in diagnosis and management of acromegaly.  Ann Clin Biochem . 2001;  38(Pt 4) 297-303
    CrossrefPubMedSearch in Google Scholar
  • 19 Clemmons D R, Van Wyk J J, Ridgway E C, Kliman B, Kjellberg R N, Underwood L E. Evaluation of acromegaly by radioimmunoassay of somatomedin-C.  N Engl J Med . 1979;  301 1138-1142
    PubMedSearch in Google Scholar
  • 20 Patel Y C, Ezzat S, Chik C L. Guidelines for the diagnosis and treatment of acromegaly: a Canadian perspective.  Clin Invest Med-Medecine Clinique et Experimentale . 2000;  23 172-187
    PubMedSearch in Google Scholar
  • 21 Melmed S. Confusion in clinical laboratory GH and IGF-I reports.  Pituitary . 1999;  2 171-172
    CrossrefPubMedSearch in Google Scholar
  • 22 Freda P U, Post K D, Powell J S, Wardlaw S L. Evaluation of disease status with sensitive measures of growth hormone secretion in 60 postoperative patients with acromegaly.  J Clin Endocrinol Metab . 1998;  83 3808-3816
    CrossrefPubMedSearch in Google Scholar
  • 23 Hall K, Sara V R. Somatomedin levels in childhood, adolescence and adult life.  Clin Endocrinol Metab . 1984;  13 91-112
    CrossrefPubMedSearch in Google Scholar
  • 24 Irie M, Tsushima T. Increase of serum growth hormone concentration following thyrotropin-releasing hormone injection in patients with acromegaly or gigantism.  J Clin Endocrinol Metab . 1972;  35 97-100
    PubMedSearch in Google Scholar
  • 25 Daughaday W H. New criteria for evaluation of acromegaly.  N Engl J Med . 1979;  301 1175-1176
    PubMedSearch in Google Scholar
  • 26 Lindholm J, Giwercman B, Giwercman A, Astrup J, Bjerre P, Skakkebaek N E. Investigation of the criteria for assessing the outcome of treatment in acromegaly.  Clin Endocrinol . 1987;  27 553-562
    PubMedSearch in Google Scholar
  • 27 Giannella-Neto D, Wajchenberg B L, Mendonca B B, Almeida S F, Macchione M, Spencer E M. Criteria for the cure of acromegaly: comparison between basal growth hormone and somatomedin C plasma concentrations in active and non-active acromegalic patients.  J Endocrinol Invest . 1988;  11 57-60
    PubMedSearch in Google Scholar
  • 28 van Lindert E, Hey O, Boecher-Schwarz H, Perneczky A. Treatment results of acromegaly as analyzed by different criteria.  Acta Neurochir . 1997;  139 905-13
    CrossrefPubMedSearch in Google Scholar
  • 29 Giustina A, Barkan A, Casanueva F F. Criteria for cure of acromegaly: a consensus statement.  J Clin Endocrinol Metab . 2000;  85 526-529
    CrossrefPubMedSearch in Google Scholar
  • 30 Holdaway I M, Rajasoorya C. Epidemiology of acromegaly.  Pituitary . 1999;  2 29-41
    CrossrefPubMedSearch in Google Scholar
  • 31 Wright A D, Hill D M, Lowy C, Fraser T R. Mortality in acromegaly.  Quarterly J Med . 1970;  39(153) 1-16
    PubMedSearch in Google Scholar
  • 32 Rajasoorya C, Holdaway I M, Wrightson P, Scott D J, Ibbertson H K. Determinants of clinical outcome and survival in acromegaly.  Clin Endocrinol . 1994;  41 95-102
    CrossrefPubMedSearch in Google Scholar
  • 33 Bates A S, Van't Hoff W, Jones J M, Clayton R N. An audit of outcome of treatment in acromegaly.  Quarterly J Med . 1993;  86 293-299
    PubMedSearch in Google Scholar
  • 34 Orme S M, McNally R J, Cartwright R A, Belchetz P E. Mortality and cancer incidence in acromegaly: a retrospective cohort study. United Kingdom Acromegaly Study Group.  J Clin Endocrinol Metabol . 1998;  83 2730-2734
    CrossrefPubMedSearch in Google Scholar
  • 35 Flogstad A K, Halse J, Haldorsen T. Sandostatin LAR in acromegalic patients: a dose-range study.  J Clin Endocrinol Metabol . 1995;  80 3601-3607
    CrossrefPubMedSearch in Google Scholar
  • 36 Flogstad A K, Halse J, Bakke S. Sandostatin LAR in acromegalic patients: long-term treatment.  J Clin Endocrinol Metabol . 1997;  82 23-28
    CrossrefPubMedSearch in Google Scholar
  • 37 Chanson P, Boerlin V, Ajzenberg C. Comparison of octreotide acetate LAR and lanreotide SR in patients with acromegaly.  Clin Endocrinol . 2000;  53 577-586
    CrossrefPubMedSearch in Google Scholar
  • 38 Davies P H, Stewart S E, Lancranjan L, Sheppard M C, Stewart P M. Long-term therapy with long-acting octreotide (Sandostatin-LAR) for the management of acromegaly.  Clin Endocrinol . 1998;  48 311-316
    CrossrefPubMedSearch in Google Scholar
  • 39 Grass P, Marbach P, Bruns C, Lancranjan I. Sandostatin LAR (microencapsulated octreotide acetate) in acromegaly: pharmacokinetic and pharmacodynamic relationships.  Metabolism . 1996;  S27-S30
    PubMedSearch in Google Scholar
  • 40 Stewart P M, Kane K F, Stewart S E, Lancranjan I, Sheppard M C. Depot long-acting somatostatin analog (Sandostatin-LAR) is an effective treatment for acromegaly.  J Clin Endocrinol Metabol . 1995;  80 3267-3272
    CrossrefPubMedSearch in Google Scholar
  • 41 Lancranjan I, Bruns C, Grass P. Sandostatin LAR: a promising therapeutic tool in the management of acromegalic patients.  Metabolism . 1996;  67-71
    PubMedSearch in Google Scholar
  • 42 Lancranjan I, Atkinson A B. Results of a European multicentre study with Sandostatin LAR in acromegalic patients. Sandostatin LAR Group.  Pituitary . 1999;  1 105-114
    CrossrefPubMedSearch in Google Scholar
  • 43 Abs R, Verhelst J, Maiter D. Cabergoline in the treatment of acromegaly: a study in 64 patients.  J Clin Endocrinol Metabol . 1998;  83 374-378
    CrossrefPubMedSearch in Google Scholar
  • 44 Colao A, Lombardi G, Annunziato L. Cabergoline.  Pharmacotherapy . 2000;  1 555-574
    PubMedSearch in Google Scholar
  • 45 Cozzi R, Attanasio R, Barausse M. Cabergoline in acromegaly: a renewed role for dopamine agonist treatment?.  Eur J Endocrinol . 1998;  139 516-521
    CrossrefPubMedSearch in Google Scholar
  • 46 Jackson S N, Fowler J, Howlett T A. Cabergoline treatment of acromegaly: a preliminary dose finding study.  Clin Endocrinol . 1997;  46 745-749
    CrossrefPubMedSearch in Google Scholar
  • 47 Minniti G, Jaffrain-Rea M L, Baldelli R. Acute effects of octreotide, cabergoline and a combination of both drugs on GH secretion in acromegalic patients.  Clin Ter . 1997;  148 601-607
    PubMedSearch in Google Scholar
  • 48 Newman C B. Medical therapy for acromegaly.  Endocrinol Metabol Clin North Am . 1999;  28 171-190
    PubMedSearch in Google Scholar
  • 49 Diez J J, Iglesias P. Current management of acromegaly.  Pharmacotherapy . 2000;  1 991-1006
    PubMedSearch in Google Scholar
  • 50 Marzullo P, Ferone D, Di Somma C. Efficacy of combined treatment with lanreotide and cabergoline in selected therapy-resistant acromegalic patients.  Pituitary . 1999;  1 115-120
    CrossrefPubMedSearch in Google Scholar
  • 51 Colao A, Ferone D, Marzullo P. Effect of different dopaminergic agents in the treatment of acromegaly.  J Clin Endocrinol Metabol . 1997;  82 518-523
    CrossrefPubMedSearch in Google Scholar
  • 52 Giusti M, Ciccarelli E, Dallabonzana D. Clinical results of long-term slow-release lanreotide treatment of acromegaly.  Eur J Clin Invest . 1997;  27 277-284
    PubMedSearch in Google Scholar
  • 53 Kendall-Taylor P, Miller M, Gebbie J, Turner S, al-Maskari M. Long-acting octreotide LAR compared with lanreotide SR in the treatment of acromegaly.  Pituitary . 2000;  3 61-65
    CrossrefPubMedSearch in Google Scholar
  • 54 Trainer P J, Drake W M, Katznelson L. Treatment of acromegaly with the growth hormone-receptor antagonist pegvisomant.  N Engl J Med . 2000;  342 1171-1177
    CrossrefPubMedSearch in Google Scholar
  • 55 Herman-Bonert V S, Zib K, Scarlett J A, Melmed S. Growth hormone receptor antagonist therapy in acromegalic patients resistant to somatostatin analogs.  J Clin Endocrinol Metabol . 2000;  85 2958-2961
    CrossrefPubMedSearch in Google Scholar
  • 56 Parkinson C, Trainer P J. Pegvisomant: a growth hormone receptor antagonist for the treatment of acromegaly.  Growth Horm Igf Res . 2000;  S119-S123
    PubMedSearch in Google Scholar
  • 57 Ross R J, Leung K C, Maamra M. Binding and functional studies with the growth hormone receptor antagonist, B2036-PEG (pegvisomant), reveal effects of pegylation and evidence that it binds to a receptor dimer.  J Clin Endocrinol Metabol . 2001;  86 1716-1723
    PubMedSearch in Google Scholar
  • 58 van der Lely J A, Muller A, Janssen J A. Control of tumor size and disease activity during cotreatment with octreotide and the growth hormone receptor antagonist pegvisomant in an acromegalic patient.  J Clin Endocrinol Metabol . 2001;  86 478-481
    CrossrefPubMedSearch in Google Scholar
  • 59 Reitsma W D. The intriguing story of somatostatin.  Neth J Med . 1976;  19 1-4
    PubMedSearch in Google Scholar
  • 60 Hall R, Snow M, Scanlon M, Mora B, Gomez-Pan A. Pituitary effects of somatostatin.  Metabolism . 1978;  S1257-S1262
    PubMedSearch in Google Scholar
  • 61 Cozzi R, Liuzzi A, Dallabonzana D. Clinical use of the somatostatin analog SMS 201-995 in endocrinology.  J Endocrinol Invest . 1988;  11 737-740
    PubMedSearch in Google Scholar
  • 62 Danila D C, Haidar J N, Zhang X, Katznelson L, Culler M D, Klibanski A. Somatostatin receptor-specific analogs: effects on cell proliferation and growth hormone secretion in human somatotroph tumors.  J Clin Endocrinol Metabol . 2001;  86 2976-2981
    CrossrefPubMedSearch in Google Scholar
  • 63 Efendic S, Hokfelt T, Luft R. Somatostatin.  Adv Metabol Disord . 1978;  9 367-424
    PubMedSearch in Google Scholar
  • 64 Epelbaum J, Agid F, Agid Y. Somatostatin receptors in brain and pituitary.  Horm Res . 1989;  31 45-50
    PubMedSearch in Google Scholar
  • 65 Reubi J C, Landolt A M. The growth hormone responses to octreotide in acromegaly correlate with adenoma somatostatin receptor status.  J Clin Endocrinol Metabol . 1989;  68 844-850
    Search in Google Scholar
  • 66 Bertherat J, Chanson P, Dewailly D. Somatostatin receptors, adenylate cyclase activity, and growth hormone (GH) response to octreotide in GH-secreting adenomas.  J Clin Endocrinol Metabol . 1993;  77 1577-1583
    CrossrefPubMedSearch in Google Scholar
  • 67 Patel Y C, Greenwood M, Panetta R. Molecular biology of somatostatin receptor subtypes.  Metabolism . 1996;  S31-S38
    PubMedSearch in Google Scholar
  • 68 Patel Y C. Molecular pharmacology of somatostatin receptor subtypes.  J Endocrinol Invest . 1997;  20 348-367
    PubMedSearch in Google Scholar
  • 69 Bauer W, Briner U, Doepfner W. SMS 201-995: a very potent and selective octapeptide analogue of somatostatin with prolonged action.  Life Sci . 1982;  31 1133-1140
    CrossrefPubMedSearch in Google Scholar
  • 70 Jackson I M, Barnard L B, Lamberton P. Role of a long-acting somatostatin analogue (SMS 201-995) in the treatment of acromegaly.  Am J Med . 1986;  81(6B) 94-101
    CrossrefPubMedSearch in Google Scholar
  • 71 Katz M D, Erstad B L. Octreotide, a new somatostatin analogue.  Clin Pharm . 1989;  8 255-273
    PubMedSearch in Google Scholar
  • 72 Farooqi S, Bevan J S, Sheppard M C, Wass J A. The therapeutic value of somatostatin and its analogues.  Pituitary . 1999;  2 79-88
    CrossrefPubMedSearch in Google Scholar
  • 73 Lamberts S W, Uitterlinden P, Verschoor L, van Dongen J K, del Pozo E. Long-term treatment of acromegaly with the somatostatin analogue SMS 201-995.  N Engl J Med . 1985;  313 1576-1580
    CrossrefPubMedSearch in Google Scholar
  • 74 Lamberts S W. A guide to the clinical use of the somatostatin analogue SMS 201-995 (Sandostatin).  Acta Endocrinol Suppl . 1987;  286 S54-S66
    PubMedSearch in Google Scholar
  • 75 Jenkins P J. The use of long-acting somatostatin analogues in acromegaly.  Growth Horm Igf Res . 2000;  S111-S114
    PubMedSearch in Google Scholar
  • 76 Stewart P M, James R A. The future of somatostatin analogue therapy.  Best Pract Res Clin Endocrinol Metab . 1999;  13 409-418
    CrossrefPubMedSearch in Google Scholar
  • 77 Colao A, Ferone D, Marzullo P. Long-term effects of depot long-acting somatostatin analog octreotide on hormone levels and tumor mass in acromegaly.  J Clin Endocrinol Metabol . 2001;  86 2779-2786
    CrossrefPubMedSearch in Google Scholar
  • 78 Cozzi R, Dallabonzana D, Attanasio R, Barausse M, Oppizzi G. A comparison between octreotide-LAR and lanreotide-SR in the chronic treatment of acromegaly.  Eur J Endocrinol . 1999;  141 267-271
    CrossrefPubMedSearch in Google Scholar
  • 79 Gillis J C, Noble S, Goa K L. Octreotide long-acting release (LAR): a review of its pharmacological properties and therapeutic use in the management of acromegaly.  Drugs . 1997;  53 681-699
    PubMedSearch in Google Scholar
  • 80 Giusti M, Sessarego P, Timossi G, Bocca L. Slow-release lanreotide and octreotide LAR in the medical therapy of acromegaly.  Eur J Endocrinol . 2000;  142 697-698
    CrossrefPubMedSearch in Google Scholar
  • 81 Hunter S J, Shaw J A, Lee K O, Wood P J, Atkinson A B, Bevan J S. Comparison of monthly intramuscular injections of Sandostatin LAR with multiple subcutaneous injections of octreotide in the treatment of acromegaly: effects on growth hormone and other markers of growth hormone secretion.  Clin Endocrinol . 1999;  50 245-251
    CrossrefPubMedSearch in Google Scholar
  • 82 Bouloux P M. Somatuline LA: a new treatment for acromegaly.  Hosp Med (London) . 1998;  59 642-645
    PubMedSearch in Google Scholar
  • 83 Lin J D, Lee S T, Weng H F. An open, phase III study of lanreotide (Somatuline PR) in the treatment of acromegaly.  Endocr J . 1999;  46 193-198
    PubMedSearch in Google Scholar
  • 84 al-Maskari M, Gebbie J, Kendall-Taylor P. The effect of a new slow-release, long-acting somatostatin analogue, lanreotide, in acromegaly.  Clin Endocrinol . 1996;  45 415-421
    CrossrefPubMedSearch in Google Scholar
  • 85 Cannavo S, Squadrito S, Curto L, Almoto B, Vieni A, Trimarchi F. Results of a two-year treatment with slow release lanreotide in acromegaly.  Horm Metab Res . 2000;  32 224-229
    PubMedSearch in Google Scholar
  • 86 Chang T C, Chang T J, Chen M H, Hsiao Y L, Tsai K S. Effectiveness of slow-release lanreotide, a long-acting somatostatin analogue, in the treatment of acromegaly.  J Formos Med Assoc . 1998;  97 684-689
    PubMedSearch in Google Scholar
  • 87 Culler M. Lanreotide and beyond: extending the therapeutic horizons.  Hosp Med (London) . 1999;  60 714-717
    PubMedSearch in Google Scholar
  • 88 Suliman M, Jenkins R, Ross R, Powell T, Battersby R, Cullen D R. Long-term treatment of acromegaly with the somatostatin analogue SR-lanreotide.  J Endocrinol Invest . 1999;  22 409-418
    CrossrefPubMedSearch in Google Scholar
  • 89 Chanson P. Somatostatin analogs in the treatment of acromegaly: the choice is now possible.  Eur J Endocrinol . 2000;  143 573-735
    CrossrefPubMedSearch in Google Scholar
  • 90 Newman C B, Melmed S, George A. Octreotide as primary therapy for acromegaly.  J Clin Endocrinol Metabol . 1998;  83 3034-3040
    CrossrefPubMedSearch in Google Scholar
  • 91 Sassolas G, Harris A G, James-Deidier A. Long-term effect of incremental doses of the somatostatin analog SMS 201- 995 in 58 acromegalic patients. French SMS 201-995 approximately equal to Acromegaly Study Group.  J Clin Endocrinol Metabol . 1990;  71 391-397
    PubMedSearch in Google Scholar
  • 92 Shi Y F, Harris A G, Zhu X F, Deng J Y. Clinical and biochemical effects of incremental doses of the long-acting somatostatin analogue SMS 201-995 in ten acromegalic patients.  Clin Endocrinol . 1990;  32 695-705
    PubMedSearch in Google Scholar
  • 93 Ezzat S, Snyder P J, Young W F. Octreotide treatment of acromegaly: a randomized, multicenter study.  Ann Intern Med . 1992;  117 711-718
    PubMedSearch in Google Scholar
  • 94 Barkan A L, Lloyd R V, Chandler W F. Preoperative treatment of acromegaly with long-acting somatostatin analog SMS 201-995: shrinkage of invasive pituitary macroadenomas and improved surgical remission rate.  J Clin Endocrinol Metabol . 1988;  67 1040-1048
    CrossrefPubMedSearch in Google Scholar
  • 95 Plockinger U, Reichel M, Fett U, Saeger W, Quabbe H J. Preoperative octreotide treatment of growth hormone-secreting and clinically nonfunctioning pituitary macroadenomas: effect on tumor volume and lack of correlation with immunohistochemistry and somatostatin receptor scintigraphy.  J Clin Endocrinol Metabol . 1994;  79 1416-1423
    CrossrefPubMedSearch in Google Scholar
  • 96 Colao A, Ferone D, Cappabianca P. Effect of octreotide pretreatment on surgical outcome in acromegaly.  J Clin Endocrinol Metabol . 1997;  82 3308-3314
    CrossrefPubMedSearch in Google Scholar
  • 97 Faglia G, Bazzoni N, Spada A. In vivo detection of somatostatin receptors in patients with functionless pituitary adenomas by means of a radioiodinated analog of somatostatin ([123I]SDZ 204-090).  J Clin Endocrinol Metabol . 1991;  73 850-856
    PubMedSearch in Google Scholar
  • 98 Lamberts S W, van der Lely J A, de Herder W W, Hofland L J. Octreotide.  N Engl J Med . 1996;  334 246-254
    CrossrefPubMedSearch in Google Scholar
  • 99 Wass J A, Popovic V, Chayvialle J A. Proceedings of the discussion, ``Tolerability and safety of Sandostatin''.  Metabolism . 1992;  S80-S82
    PubMedSearch in Google Scholar
  • 100 Wynick D, Bloom S R. Clinical review 23: the use of the long-acting somatostatin analog octreotide in the treatment of gut neuroendocrine tumors.  J Clin Endocrinol Metabol . 1991;  73 1-3
    PubMedSearch in Google Scholar
  • 101 Giusti M, Cuttica C M, Cariola G, Valenti S, Sessarego P, Giordano G. Treatment of acromegaly with octreotide: effectiveness and tolerability of its pulsatile administration by portable pump.  Recenti Prog Med . 1995;  86 189-194
    PubMedSearch in Google Scholar
  • 102 Jaffe C A, Barkan A L. Treatment of acromegaly with dopamine agonists.  Endocrinol Metabol Clin North Am . 1992;  21 713-735
    PubMedSearch in Google Scholar
  • 103 Stewart P M. Current therapy for acromegaly.  Trends Endocrinol Metabol . 2000;  11 128-132
    PubMedSearch in Google Scholar
  • 104 Parkinson C, Trainer P J. Growth hormone receptor antagonists therapy for acromegaly.  Best Pract Res Clin Endocrinol Metab . 1999;  13 419-430
    CrossrefPubMedSearch in Google Scholar
  • 105 Jackson I M, Noren G. Role of gamma knife radiosurgery in acromegaly.  Pituitary . 1999;  2 71-77
    CrossrefPubMedSearch in Google Scholar
  • 106 Jaffe C A. Reevaluation of conventional pituitary irradiation in the therapy of acromegaly.  Pituitary . 1999;  2 55-62
    CrossrefPubMedSearch in Google Scholar
  • 107 Kim M S, Lee S I, Sim J H. Gamma Knife radiosurgery for functioning pituitary microadenoma.  Stereotact Funct Neurosurg . 1999;  S119-S124
    PubMedSearch in Google Scholar
  • 108 Landolt A M, Haller D, Lomax N. Stereotactic radiosurgery for recurrent surgically treated acromegaly: comparison with fractionated radiotherapy.  J Neurosurg . 1998;  88 1002-1008
    PubMedSearch in Google Scholar
  • 109 Powell J S, Wardlaw S L, Post K D, Freda P U. Outcome of radiotherapy for acromegaly using normalization of insulin-like growth factor I to define cure.  J Clin Endocrinol Metabol . 2000;  85 2068-2071
    CrossrefPubMedSearch in Google Scholar
  • 110 Zhang N, Pan L, Wang E M, Dai J Z, Wang B J, Cai P W. Radiosurgery for growth hormone-producing pituitary adenomas.  J Neurosurg . 2000;  6-9
    PubMedSearch in Google Scholar
  • 111 Eastman R C, Gorden P, Glatstein E, Roth J. Radiation therapy of acromegaly.  Endocrinol Metabol Clin North Am . 1992;  21 693-712
    PubMedSearch in Google Scholar
  • 112 Eastman R C, Gorden P, Roth J. Conventional supervoltage irradiation is an effective treatment for acromegaly.  J Clin Endocrinol Metabol . 1979;  48 931-940
    PubMedSearch in Google Scholar
  • 113 Goffman T E, Dewan R, Arakaki R, Gorden P, Oldfield E H, Glatstein E. Persistent or recurrent acromegaly: long-term endocrinologic efficacy and neurologic safety of postsurgical radiation therapy.  Cancer . 1992;  69 271-275
    PubMedSearch in Google Scholar
  • 114 Feek C M, McLelland J, Seth J. How effective is external pituitary irradiation for growth hormone-secreting pituitary tumors?.  Clin Endocrinol . 1984;  20 401-408
    PubMedSearch in Google Scholar
  • 115 Barkan A L, Halasz I, Dornfeld K J. Pituitary irradiation is ineffective in normalizing plasma insulin-like growth factor I in patients with acromegaly.  J Clin Endocrinol Metabol . 1997;  82 3187-3191
    CrossrefPubMedSearch in Google Scholar
  • 116 Biermasz N R, Dulken H V, Roelfsema F. Postoperative radiotherapy in acromegaly is effective in reducing GH concentration to safe levels.  Clin Endocrinol . 2000;  53 321-327
    CrossrefPubMedSearch in Google Scholar
  • 117 Biermasz N R, van Dulken H, Roelfsema F. Long-term follow-up results of postoperative radiotherapy in 36 patients with acromegaly.  J Clin Endocrinol Metabol . 2000;  85 2476-2482
    CrossrefPubMedSearch in Google Scholar
  • 118 Gutt B, Hatzack C, Morrison K, Pollinger B, Schopohl J. Conventional pituitary irradiation is effective in normalising plasma IGF-I in patients with acromegaly.  Eur J Endocrinol . 2001;  144 109-116
    CrossrefPubMedSearch in Google Scholar
  • 119 Critides S D. Glioblastoma after radiotherapy.  Neurosurgery . 1988;  22(6 pt 1) 1115
    PubMedSearch in Google Scholar
  • 120 Abe T, Ludecke D K. Recent results of secondary transnasal surgery for residual or recurring acromegaly.  Neurosurgery . 1998;  42 1013-22
    CrossrefPubMedSearch in Google Scholar
  • 121 Abe T, Ludecke D K. Recent primary transnasal surgical outcomes associated with intraoperative growth hormone measurement in acromegaly.  Clin Endocrinol . 1999;  50 27-35
    CrossrefPubMedSearch in Google Scholar
  • 122 Abosch A, Tyrrell J B, Lamborn K R, Hannegan L T, Applebury C B, Wilson C B. Transsphenoidal microsurgery for growth hormone-secreting pituitary adenomas: initial outcome and long-term results.  J Clin Endocrinol Metabol . 1998;  83 3411-3418
    CrossrefPubMedSearch in Google Scholar
  • 123 Arafah B U, Brodkey J S, Kaufman B, Velasco M, Manni A, Pearson O H. Transsphenoidal microsurgery in the treatment of acromegaly and gigantism.  J Clin Endocrinol Metabol . 1980;  50 578-585
    PubMedSearch in Google Scholar
  • 124 Biermasz N R, van Dulken H, Roelfsema F. Ten-year follow-up results of transsphenoidal microsurgery in acromegaly.  J Clin Endocrinol Metabol . 2000;  85 4596-4602
    CrossrefPubMedSearch in Google Scholar
  • 125 Clayton R N, Stewart P M, Shalet S M, Wass J A. Pituitary surgery for acromegaly: should be done by specialists.  Br Med J . 1999;  319(7210) 588-589
    PubMedSearch in Google Scholar
  • 126 Fahlbusch R, Honegger J, Buchfelder M. Surgical management of acromegaly.  Endocrinol Metabol Clin North Am . 1992;  21 669-692
    PubMedSearch in Google Scholar
  • 127 Fahlbusch R, Honegger J, Buchfelder M. Acromegaly: the place of the neurosurgeon.  Metabolism . 1996;  S65-S66
    PubMedSearch in Google Scholar
  • 128 Fahlbusch R, Honegger J, Buchfelder M. Evidence supporting surgery as treatment of choice for acromegaly.  J Endocrinology . 1997;  S53-S55
    PubMedSearch in Google Scholar
  • 129 Laws Jr R E, Piepgras D G, Randall R V, Abboud C F. Neurosurgical management of acromegaly: results in 82 patients treated between 1972 and 1977.  J Neurosurg . 1979;  50 454-461
    PubMedSearch in Google Scholar
  • 130 Laws E R, Vance M L, Thapar K. Pituitary surgery for the management of acromegaly.  Horm Res . 2000;  S71-S75
    PubMedSearch in Google Scholar
  • 131 Lissett C A, Peacey S R, Laing I, Tetlow L, Davis J R, Shalet S M. The outcome of surgery for acromegaly: the need for a specialist pituitary surgeon for all types of growth hormone (GH) secreting adenoma.  Clin Endocrinol . 1998;  49 653-657
    CrossrefPubMedSearch in Google Scholar
  • 132 Puchner M J, Knappe U J, Ludecke D K. Pituitary surgery in elderly patients with acromegaly.  Neurosurgery . 1995;  36 677-683
    PubMedSearch in Google Scholar
  • 133 Sheaves R, Jenkins P, Blackburn P. Outcome of transsphenoidal surgery for acromegaly using strict criteria for surgical cure.  Clin Endocrinol . 1996;  45 407-413
    CrossrefPubMedSearch in Google Scholar
  • 134 Shimon I, Cohen Z R, Ram Z, Hadani M. Transsphenoidal surgery for acromegaly: endocrinological follow-up of 98 patients.  Neurosurgery . 2001;  48 1239-1243
    PubMedSearch in Google Scholar
  • 135 Tindall G T, Oyesiku N M, Watts N B, Clark R V, Christy J H, Adams D A. Transsphenoidal adenomectomy for growth hormone-secreting pituitary adenomas in acromegaly: outcome analysis and determinants of failure.  J Neurosurg . 1993;  78 205-215
    PubMedSearch in Google Scholar
  • 136 Freda P U, Wardlaw S L, Post K D. Long-term endocrinological follow-up evaluation in 115 patients who underwent transsphenoidal surgery for acromegaly.  J Neurosurg . 1998;  89 353-358
    PubMedSearch in Google Scholar
  • 137 Ross D A, Wilson C B. Results of transsphenoidal microsurgery for growth hormone-secreting pituitary adenoma in a series of 214 patients.  J Neurosurg . 1988;  68 854-867
    PubMedSearch in Google Scholar
  • 138 Swearingen B, Barker II G F, Katznelson L. Long-term mortality after transsphenoidal surgery and adjunctive therapy for acromegaly.  J Clin Endocrinol Metabol . 1998;  83 3419-3426
    CrossrefPubMedSearch in Google Scholar
  • 139 Serri O, Somma M, Comtois R. Acromegaly: biochemical assessment of cure after long-term follow-up of transsphenoidal selective adenomectomy.  J Clin Endocrinol Metabol . 1985;  61 1185-1189
    PubMedSearch in Google Scholar
  • 140 Truong U, Hardy J, Serri O. Evaluation of biochemical cure after long-term follow-up of 59 acromegalic patients who underwent transsphenoidal microsurgery [abstract]. Paper presented at Endocrine Society, 1999, San Diego, CA
  • 141 Buchfelder M, Brockmeier S, Fahlbusch R, Honegger J, Pichl J, Manzl M. Recurrence following transsphenoidal surgery for acromegaly.  Horm Res . 1991;  35 113-118
    PubMedSearch in Google Scholar
  • 142 Buchfelder M, Fahlbusch R, Schott W, Honegger J. Long-term follow-up results in hormonally active pituitary adenomas after primary successful transsphenoidal surgery.  Acta Neurochir Suppl . 1991;  53 S72-S76
    PubMedSearch in Google Scholar
  • 143 Long H, Beauregard H, Somma M, Comtois R, Serri O, Hardy J. Surgical outcome after repeated transsphenoidal surgery in acromegaly.  J Neurosurg . 1996;  85 239-247
    CrossrefPubMedSearch in Google Scholar