Treatment of Pituitary Gigantism When Surgery Cannot Achieve Cure or Extensive Cavernous Sinus Invasion Is Present

Surgical resection is the standard first consideration in pituitary gigantism, but not all patients are surgical candidates and not all tumours are resectable to cure. This protocol addresses the structured treatment approach for the specific subset where surgery is not a viable curative option.

Clinical Scenario

This protocol applies when pituitary gigantism cannot be cured by surgery, when extensive cavernous sinus invasion is present without optic chiasm compression, or when the patient is a poor surgical candidate for any reason.

Treatment Approach (Overview)

Primary medical therapy is the indicated strategy in this setting. The approach centres on a specific class of agents; the complete regimen, agent selection, and management algorithm are available in the full protocol.

Biochemical Treatment Goals

Targets include an age-normalized serum IGF-1 and a random GH below 1.0 µg/L. Consistent use of the same hormonal assays throughout management is recommended for reliable monitoring.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1016/B978-0-12-814537-1.00002-6

Primary medical therapy with a somatostatin analog is recommended in those who cannot be cured by surgery, or have extensive cavernous sinus invasion, and do not have chiasmal compression, or are poor surgical candidates.

According to the 2014 Guidelines from the Endocrine Society, the main biochemical goals for treatment of acromegaly are an age-normalized serum IGF-1 value (disease control), a random GH < 1.0 µg/L (correlates with disease control), and to use the same hormonal assays throughout management.

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