Although it seems likely, it is unknown whether successful treatment of acromegaly will reduce the risk of neoplasia. The primary mode of therapy for acromegaly is surgery to reverse the mass effect and attempt biochemical cure. Surgical cure is dependent on surgical skill and experience as well as the size of the tumor. Residual disease following transsphenoidal surgery is therefore common, indicating the need for adjuvant therapy. Hypopituitarism is a significant complication of radiation therapy therefore, in most patients, medical management may be necessary in surgically non-cured patients in lieu of or in combination with radiation.
Medical management is a highly useful adjuvant therapy for patients with residual disease.
Therefore, it may be reasonable to attempt a course of bromocriptine as adjuvant medical therapy but it may have limited value. In addition, large doses are often required and this therapy may be associated with significant side effects. The most efficacious form of medical therapy available includes somatostatin analogs, such as octreotide. Many studies have demonstrated the efficacy of octreotide in the management of acromegaly. The initial octreotide dose is usually 50 ug b.i.d., and doses may be increased to 250 or 500 ug t.i.d.