Acromegaly
ICD-10 E22.0 · ICD-11 5A60.0

Treatment of Acromegaly When the Tumor Cannot Be Cured by Surgery — Extensive Cavernous Sinus Invasion

In certain patients with acromegaly, surgery is not a viable curative option. This protocol covers the specific clinical situation where the tumor has extensive cavernous sinus invasion without optic chiasm compression, or where the patient is a poor surgical candidate, and defines the recommended primary management approach and biochemical treatment goals.

Clinical Scenario

Surgery cannot cure

The tumor is not amenable to surgical cure due to extensive cavernous sinus invasion. Optic chiasm compression is absent. The patient may additionally be a poor surgical candidate for independent reasons. In this setting, a primary non-surgical strategy is appropriate.

Treatment Approach — Partial Overview

Primary medical therapy with a somatostatin receptor ligand (SRL) is recommended for this scenario. Specific agents, dosing, titration intervals, and the complete structured regimen are available in the full protocol below.

Treatment Goals

Biochemical control is defined as achieving an age-normalized serum IGF-1 value and a random GH below 1.0 µg/L. Serum IGF-1 and GH are measured after 12 weeks of therapy, just prior to the next scheduled dose.

Instant Access to Structured Evidence-Based Regimens

References

  1. We suggest use of an SRL as primary therapy in a patient who cannot be cured by surgery, has extensive cavernous sinus invasion, does not have chiasmal compression, or is a poor surgical candidate.
  2. We suggest a biochemical target goal of an age-normalized serum IGF-1 value, which signifies control of acromegaly.
  3. We suggest using a random GH < 1.0 µg/L as a therapeutic goal, as this correlates with control of acromegaly.
  4. Effectiveness of treatment is based on measurement of serum IGF-1 and GH, which should be measured after 12 weeks just prior to the next dose.
DOI: 10.1210/jc.2014-2700 View source ↗