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How is acromegaly treated through surgery?

Surgery is the first option recommended for most people with acromegaly because it is often a rapid and effective treatment. A surgeon reaches the pituitary via an incision through the nose or inside the upper lip and, with special tools, removes the tumor tissue in a procedure called transsphenoidal surgery. This procedure promptly relieves the pressure on the surrounding brain regions and leads to a rapid lowering of GH levels. If surgery is successful, facial appearance and soft tissue swelling improve within a few days.

Surgery is most successful in patients with blood growth hormone (GH) levels below 45 ng/ml before the operation and with pituitary tumors no larger than 10 mm in diameter. Success depends in large part on the skill and experience of the surgeon as well as the location of the tumor. Even with the most experienced neurosurgeon, the chance of a cure is small if the tumor has extended into critical brain structures or into the cavernous sinus where surgery could be risky.

The success rate also depends on what level of GH is defined as a cure. The best measure of surgical success is normalization of GH and insulin-like growth factor 1 (IGF-I) levels. The overall rate of remission?control of the disease?after surgery ranges from 55 percent to 80 percent.

A possible complication of surgery is damage to the surrounding normal pituitary tissue, which requires a lifelong use of pituitary hormone replacement. The part of the pituitary that stores antidiuretic hormone?hormone important in water balance?may be temporarily or, rarely, permanently damaged, and the patient may require medical therapy. Other potential problems include cerebrospinal fluid (CSF) leaks and, rarely, meningitis. CSF bathes the brain and can leak from the nose if the incision area doesn't heal well. Meningitis is a bacterial or viral infection of the meninges, the outer covering of the brain.

Even when surgery is successful and hormone levels return to normal, people with acromegaly must be carefully monitored for years for possible recurrence of the disease. More commonly, hormone levels improve but do not return to normal. Additional treatment, usually medications, may be required.

This answer is based on source  information from the National Institute of Diabetes and Digestive and Kidney Diseases

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