Surgical cure is dependent on surgical skill and experience as well as the size of the tumor. The literature regarding cure rates following surgery is complicated by the fact that different series use various definitions of cure. Residual disease following transsphenoidal surgery is therefore common, indicating the need for adjuvant therapy. Hypopituitarism is a significant complication of radiation therapy. Adjunctive therapy is critical, particularly because persistent acromegaly is associated with the increased mortality and risk of malignancy.
Medical management is a highly useful adjuvant therapy for patients with residual disease.
Medical therapy can be used alone or during the interval between administration of radiation and normalization of the serum IGF-1 level. Therefore, although it is reasonable to attempt a course of bromocriptine as adjuvant medical therapy, it will be effective in only a small minority of patients. In addition, large doses are associated with significant side effects. The most effective form of medical therapy available is the somatostatin analogue, octreotide. Native somatostatin administration results in a marked reduction in circulating growth hormone levels, but the half life is only several minutes and it is therefore inadequate for clinical use.