Considerations
• If majority of tumor
unresectable and no
chiasmal compression
• Poor surgical candidate
Surgical
debulking
Transsphenoidal surgery
(most patients)
Medications
• Annual IGF-1 and
random GH
• Consider OGTT
MRI
(If clinical or biochemical
signs of recurrence)
SRL
(for most)
DA
(mild disease)
Pegvisomant
• Partial clinical and biochemical response to
maximal doses
- consider combination therapy of above drugs
• No clinical and biochemical response
- consider alternative monotherapy
Ineffective or intolerable medications
Consider SRT
(conventional radiation if not a candidate)
Radiation therapy may be
considered at any point
following incomplete surgery
Persistent disease
(Incomplete surgery)
Management of Acromegaly
Remission
DA, dopamine agonist; GH, growth hormone; IGF-1, insulin-like growth factor-1; MRI,
magnetic resonance imaging ; OGTT, oral glucose tolerance test; SR L , somatostatin
receptor ligand; SRT, stereotactic radiotherapy
