Acromegaly and pituitary surgery: getting ready

Treatment for acromegaly often involves pituitary surgery because it has the potential to result in remission. At the very least, surgery may help reduce the amount of medication required to keep growth hormone (GH) levels in check. Dr. Rowena Ridout, an endocrinologist at Toronto Western Hospital, in Ontario, talks about what to expect with pituitary surgery and how to prepare for it.

Surgical results vary with each patient

Success with pituitary surgery depends on how much of the tumour can be removed; the success rate is much higher for smaller tumours. In addition, the location of the tumour and whether it has grown into surrounding structures will determine whether the neurosurgeon can safely remove the tumour. The MRI scan will help your healthcare team to determine whether there is a possibility that surgery will result in remission. Even if the tumour cannot be completely removed, reducing the amount of the tumour through surgery can help your GH levels be more easily controlled by medication.

Recovery will take time

Most pituitary surgeries are transsphenoidal, which means gaining access to the tumour through the nose and sphenoid bone. Transsphenoidal surgery is performed using the endoscope technique or the microscope technique. Starting immediately after surgery, you may have headaches, stuffiness, sinus congestion and fatigue for a few weeks. Depending on the surgical technique used (i.e., endoscope or microscope), your nasal passages may be packed with gauze for a few days. And, the transsphenoidal approach means that there is no incision to heal. If the surgery is successful, the soft tissue swelling will start to decrease within a few days, and your hands, feet and face should begin to look and feel smaller. However, bony changes such as forehead and jaw protrusion will not go away because the surgery cannot reverse bone growth.

Quality of life may improve after surgery

As the recovery continues, you may find that you are sleeping better, have more energy and generally feel better. Certain symptoms of acromegaly may also disappear over time such as carpal tunnel syndrome, increased sweating and sleep apnea. Joint pain, diabetes and blood pressure control should also improve, and if you had headaches related to the tumour, they may resolve. You may notice these changes anywhere from a few weeks to a few months after surgery.

Preparation may be required

If you are working, you should plan to book 6 to 8 weeks off work for recovery. The amount of time you need to take off will depend on your general health and the demands of your job. Patients on certain medications, like blood thinners, may have to stop taking them before surgery. In some cases, patients are started on medication in advance of surgery to reduce growth hormone levels to help the surgery go more smoothly.

Plan to stay over a few nights in the hospital

During the pre-operative visit, you will meet with the surgeon and anesthetist. The surgeon will talk to you about the procedure and how long you will have to stay in the hospital. Your length of stay depends on whether you have other conditions associated with acromegaly, like sleep apnea or heart disease. Usually, patients are in the hospital for 2 to 5 days following surgery. However, if there are complications, such as leakage of cerebral spinal fluid (CSF), pituitary hormone problems, or problems with fluid balance (diabetes insipidus), your hospital stay may be extended.

Ask your healthcare team questions

Here are some important questions to ask your healthcare team before surgery:

  • Is my surgeon an experienced pituitary surgeon?

  • How will my surgery be performed (i.e., with an endoscope or a microscope)?

  • When can I go back to work?

  • What activity limitations will I have?

  • How long after surgery will I follow-up with the surgeon and endocrinologist?

  • When will my hormone levels be retested?

  • When will I repeat the MRI scan?

Remember, your healthcare team is there to support you and answer any questions you may have about acromegaly and your treatment.

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

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