Surgery

Surgery can cure acromegaly if the entire tumour, or adenoma, can be removed. The smaller the adenoma is, the more likely that surgery will be effective at curing acromegaly. Success with surgery is closely related to the surgeon’s experience, so it is important to have a surgeon who is experienced in pituitary surgery.

Small adenomas are called microadenomas and are less than 1 cm in diameter. Macroadenomas are adenomas that are 1 cm in diameter or larger and, in many cases, are less likely to be cured with surgery alone.

Microadenomas and most macroadenomas can be removed using transsphenoidal surgery. Your doctor will determine if you are an appropriate candidate for surgical treatment for acromegaly.

Transsphenoidal surgery

In transsphenoidal surgery, the surgeon makes a small hole in the bony wall of the sphenoid sinus, which is a hollow space in the bone. The surgeon can access the sphenoid sinus through the nose or underneath the upper lip. After the hole is made, the pituitary adenoma can be pulled out through the sphenoid sinus cavity.

If the pituitary adenoma is larger, the surgeon will remove small pieces of it, one at a time, until as much of the adenoma has been removed as possible.

The pituitary adenoma can be reached through the nose or under the upper lip

Transsphenoidal surgery route through the nostril

Risks

As with any type of surgery, transsphenoidal surgery has risks. The most common risks associated with transsphenoidal surgery are:

  • Damage to the pituitary gland causing a shortage of other pituitary gland hormones

  • Serious bleeding

  • Damage to the part of the brain that controls vision

  • Infection in the lining of the brain (meningitis)

  • Reaction to the anesthesia

These risks can be minimized by selecting a surgeon with a lot of experience performing pituitary surgery. During your pre-operative visit, your surgeon will explain to you all the risks associated with the specific transsphenoidal surgery you will be having. Use this opportunity to ask any questions you have and make sure you understand the answers.

Check out the true-2-me guest editorial on treatment Considerations for Acromegaly


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