Surgical treatment of acromegaly
For most people with acromegaly, surgery to remove or reduce the size of the tumour in the pituitary gland is the first approach.
Surgical removal of the tumour can dramatically reduce the amount of growth hormone in your body, as well as ease some of the pressure problems caused by the presence of the tumour, such as headaches and visual problems.
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What are the aims of surgery?
The main aim of surgery is to remove the tumour completely.
If this is not possible, because parts of the tumour have grown into surrounding structures where they cannot be removed, the goal is to reduce the size of the tumour as much as possible.
How is surgery performed?
Surgical procedures used today are very sophisticated, and a neurosurgeon who specializes in removing pituitary tumours will carry out your operation. This type of surgery is always performed under general anesthesia, which means that you will be put to sleep by an anesthesiologist before the procedure.
The vast majority of procedures will be carried out through the nose of the patient as this is the most direct way to access the pituitary gland. The operation usually lasts a total of three to six hours and most people are in the hospital for only a few days.
Surgery can be performed either as a microneurosurgical or an endoscopic procedure. The method used depends on the preference of the surgeon who carries out the operation. In experienced hands, both will yield equally good results.
During the surgery, the neurosurgeon will remove small pieces of bone to expose the pituitary gland and the tumour.
In some cases, an operation through the skull (transcranial surgery) may need to be done instead.
Whether it is possible to completely remove the tumour and restore growth hormone levels to normal depends on the size and position of the tumour.
If the tumour is small and completely accessible, surgery alone may be successful and no further treatment will be required.
Are there side effects from the surgery?
Your surgeon will advise you about the possible complications that sometimes result from the surgery.
No surgery is without risks, and sometimes the operation may damage some other parts of the pituitary gland. In turn, this damage may cause a reduced production of some other hormones. If this occurs, you can take replacement hormone therapy. This replacement hormone therapy may only be for a short while after your operation, or it may be for the rest of your life.
When you first wake up after the surgery, you may feel a little groggy and confused. You may also experience side effects from the general anesthetic such as feeling sick or having a sore throat or chills.
Pain relievers and other medications will be given to you to ease these temporary symptoms. You may also feel very tired after the surgery.
It is important to let your healthcare team know immediately if you feel unwell for any reason in the first few weeks after your operation, especially if you have severe headaches or notice clear fluid coming down one or both nostrils.
Clear fluid escaping down the nostrils is potentially due to a leak of the cerebral spinal fluid (CSF) that surrounds the brain, and you might need an operation to seal the leaking area. There is a small risk of meningitis while the leak remains, so it is important to see your endocrinologist or neurosurgeon as soon as possible.
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