How are patients with acromegaly refractory to surgical intervention managed?
For patients with acromegaly who are not candidates for surgery, or for whom surgery is unsuccessful, alternative approaches, such as irradiation and pharmacological therapy, are required. In recent years, the use of pituitary irradiation has declined. The technique is commonly associated with adverse effects, including hypopituitarism. Furthermore, following administration of irradiation there is often a prolonged period – sometimes years – before maximal GH suppression is attained, and IGF-1 levels are seldom normalized.12 Pharmacological therapy is indicated for second-line use following surgery and/or irradiation, and in the interim period after irradiation when hormone levels remain elevated. Indeed, recent treatment guidelines propose that pharmacological therapy may be a viable alternative to irradiation for patients who remain refractory to surgical treatment.
