Surgical management of acromegaly.

Surgery is generally the primary therapy of choice in acromegaly, and the predominantly used transsphenoidal approach has proved to be efficient and safe. Surgical results are dependent on preoperative tumor size and extension and preoperative growth hormone levels. Invasion appears to be the most important factor in predicting surgical outcome. Growth hormone levels can be normalized in 71% of all cases and in more than 80% of microadenomas. Persistent growth hormone excess may require reoperation, radiotherapy, or medical treatment. With close interdisciplinary cooperation of neurosurgeons, endocrinologists, and radiotherapists, nearly all acromegalic patients can be successfully treated today.