treatment of acromegaly? - malik1223

[ArchivalUser]

if a pituitary adenoma was found to be that cause, what would you go for first? octreotide or transsphenoidal surgery?

[ArchivalUser]

did anyone listen to the endocrine DVD's? uptil now, the guy contradicted the notes twice!
in cases of galactorrhes and other sxs of hyperprolactinemias, he said your next step is to rule out hypothyroid/pregnancy/meds BEFORE ordering a PRL levels!! (which doesnt make sense)

and in acromegaly, he said octreotide is the treatment of choice, not surgery!!?

[ArchivalUser]

After transsphenoidal surgery, somatostatin analogues are generally the first line of treatment, followed by GH receptor antagonist or dopamine agonists.
so the tratement is essensially surgical then use octreotide .

[ArchivalUser]

by the way the reference is medscape.

[ArchivalUser]

yea i just checked it there...but the guy in the videos confused me!
thanks..

[ArchivalUser]

As far as i rememver, mtb2 also starts with drugs follwed by surgery for GH excess

[ArchivalUser]

@residency: no, it has surgery as first choice.. followed by meds.. MTB2

[ArchivalUser]

Hi,
According to UpToDate:

For a patient who has a microadenoma, a macroadenoma that appears to be fully resectable, or a macroadenoma causing impairment of vision, we recommend transsphenoidal surgery

For patients whose adenoma does not appear to be fully resectable and for patients whose risk of surgery is great or who choose not to have surgery, we suggest primary therapy with a long-acting somatostatin analog .


For patients who have undergone transsphenoidal surgery with normalization of serum IGF-I concentration, we suggest no further therapy .
For patients who have undergone transsphenoidal surgery without normalization of serum IGF-I concentration, we suggest adjuvant therapy with a long-acting somatostatin analog .

If somatostatin analogs (with or without added cabergoline) are ineffective, we suggest pegvisomant for controlling IGF-I levels . If pegvisomant or somatostatin alone is unsuccessful in controlling IGF-I, we recommend a combination of pegvisomant and a somatostatin analog.

In patients who have a continued increase in adenoma size despite medical therapy (ie, somatostatin analog plus pegvisomant), we suggest radiotherapy or repeat surgery .


Take care

[ArchivalUser]

awesome!
thanks