Surgical Treatment of Acromegaly

Abstract

The results of pituitary surgery, until about 20 years ago, were assessed only in terms of survival time, working capacity, and improvement of vision [36, 38]. Endocrine improvement could not be documented and, therefore, was not a goal of surgical treatment of hypophyseal tumors. Adenomas situated entirely inside the sella were therefore usually irradiated. However, even in the earliest periods of pituitary surgery, postoperative improvement and, possibly, cure of acromegaly were occasionally observed particularly after transsphenoidal operations. Hochenegg was probably the first surgeon to observe the astonishing reduction in preoperative swelling of the hands and feet in a 31-year-old woman. The change occurred within days of transnasal adenoma extirpation [20, 45]. A similar case was observed by Kocher [24]. This latter patient also noticed that the previous acroparesthesias disappeared within days of the operation. The patient died one month later because of “brain swelling” (?). The autopsy demonstrated an incomplete removal of the tumor. Cushing [5] observed out of 12 patients operated on for acromegaly one patient (case XXVI) who experienced “not only an immediate relief of subjective discomforts, but the acromegalic manifestations, so far as the thickening and edema of the soft parts were concerned, showed marked amelioration”. The acromegalic symptoms, unfortunately, recurred one year later. Cushing [5] summarized his experiences as follows: “..., it must remain for the time-being a matter of uncertainty as to whether or not, in the absence of a degree of hyperplasia sufficient to cause neighbourhood symptoms, operative measures can hold out any promise to permanently controlling the disorder”.