Acromegaly is a rare condition in which a tumor within the pituitary gland causes excessive release of growth hormones. This can result in a patient experiencing rabid growth of their hands and feet, development of diabetes mellitus and possible cardiac complications.
Andrew Fabiano, MD, MBA, FAANS, Director of the Spinal Oncology Center at Roswell Park Comprehensive Cancer Center, provides an overview on surgical options that can lead to a cure for acromegaly and discusses a case study in which a young woman was diagnosed with the condition, underwent surgery to correct it and was able to have a full recovery.
Hello, my name is Doctor Andrew Fabiano. I'm a professor of neurosurgery at Roswell Park Comprehensive Cancer Center, and today I'm gonna speak about acromegaly. Acromegaly is a condition where you have excess growth hormone resulting in a constellation of clinical problems, particularly today we're gonna be talking about the situation where pituitary adenoma results in the excess growth hormone in a patient. acromegaly can cause a lot of problems for a patient from insulin dependent diabetes mellitus to enlargement of body parts, cardiomyopathy, and if untreated, can be. Severe and also put a patient's life at risk. Patients with acromegaly have the potential to be cured, and in many patients I've seen dramatic improvement from when they initially showed up with this endocrine abnormality to the time that they've been treated and been able to get back to a normal life. Treating patients with acromegaly first starts with making the right diagnosis. Being able to make that diagnosis, I really work hand in hand with endocrinologists in the community and other physicians. Try to first ensure an accurate diagnosis at Roswell we have dedicated neuroimaging specifically for pituitary tumors that can allow us to view the location of the pituitary tumor within the pituitary gland. At that point they'll be counseled on whether or not surgery may be the best treatment option for them. Many of these patients may have underlying cardiac abnormalities, and if needed we have an in-house cardiologist who can assist us on preparing. Patients for surgery. When it comes time to actually perform surgery for a pituitary tumor removal, we have an active skull based program here at Roswell Park. All of these cases are performed with two lead surgeons would be a neurosurgeon such as myself and a head and neck surgeon. The head and neck surgeon performs the approach to the area of the pituitary tumor and then works with me during the resection of the tumor. These are complicated surgeries. And we use an expanded endoscopic approach to really get the best visualization to try to remove the tumor while attempting to preserve the normal pituitary gland. Acromegaly can be a very challenging condition because if even a small amount of tumor remains within the pituitary gland, it can continue to lead to an abnormally high hormone level and prevent the patient from being cured after surgery, patients are typically initially kept in our intensive care unit where we have a team of intensivists who. Who will work with us to manage the patient's conditions. These patients are at risk for complications such as diabetes insippidus and also many have insulin dependent diabetes mellitus, and we have a specific insulin protocol for managing these patients while in the hospital. Typically these patients can be discharged home after 3 or 4 days. And then we'll follow up with my team, the head and neck surgeon's team, and their endocrinologist. In many cases we are able to achieve a surgical cure for acromegaly and certainly this is a wonderful outcome. I can think of a particular patient who was a young girl in her 20s who started to experience rapid growth in her hands and feet and well as changes to her face. She also had headaches and a general feeling of unwell. We were able to make the diagnosis of acromegaly due to a pituitary tumor successfully. Moved the tumor and she was cured of her acromegaly and her pituitary function remained within normal limits and this is particularly important for a young woman of childbearing age so that she's not required to be on hormone replacement for the rest of her life. There are times that we're not able to cure this tumor surgically. There are some cases where the tumor may be invading the cavernous sinus or in another unresectable location or that even after multiple surgeries the patient continues to have endocrine abnormalities. For those cases we do have another outstanding treatment called Gamma knife radiosurgery that can be used to treat these tumors. We're one of the larger Gamma Knife radiosurgical centers in the country, and we have a lot of expertise in treating pituitary tumors at Roswell, we're pleased to offer neurosurgeons and head and neck surgeons who specialize in the treatment of pituitary. Tumors neuroradiy that has dedicated pituitary imaging and a gamma knife radiosurgical center. We'd be happy to help assist you in the care of any patients with acromegaly or other pituitary disorders. Please don't hesitate to contact us if we can provide more information or if we can assist with patient care in any way.
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