Preoperative medical treatments and surgical approaches for acromegaly: A systematic review

Objective Acromegaly is a condition characterized by an overproduction of growth hormone which infers high morbidity and mortality if left untreated. The objective of this review is to analyse and appraise the current evidence for the generalized use of preoperative medications and the various surgical approaches as described in the literature. Design A thorough search from MEDLINE via PubMed, EMBASE, and Cochrane Library has been performed which identified a total of 37 papers. Conclusion The preoperative use of somatostatin receptor agonists (SAs) in acromegaly is a controversial topic with current guidelines suggesting against their generalized routine use. Most authors noticed an insignificant long-term remission of acromegaly when given SAs compared with nil preoperative therapy, except for invasive macroadenomas as SAs have been found to reduce the tumour volume and aid towards the total resection of the adenoma. Furthermore, according to the evidence available, endoscopic transsphenoidal surgery is the optimum method for hypophysectomy in terms of its remission and safety profile.

Automated summary

This review analyzes and evaluates the current evidence for the use of preoperative medications and different surgical approaches in acromegaly. The use of somatostatin receptor agonists (SAs) as preoperative treatment for acromegaly is controversial, with guidelines suggesting against their routine use. However, SAs have been found to reduce tumor volume and aid in total adenoma resection for invasive macroadenomas. Furthermore, endoscopic transsphenoidal surgery is considered the optimal method for hypophysectomy in terms of remission and safety profile.