Such tumors frequently cause local anatomic compression, resulting in visual field deficits, headaches, hypopituitarism, and cranial nerve palsies. There is a 2 to 5 fold increase in the mortality rate in acromegalic patients largely due to cardiovascular and cerebrovascular disease. There is also an increased rate of malignancy associated with acromegaly, with colon cancer the best characterized. IGF-1 feeds back at the level of the hypothalamus and pituitary resulting in a reduction in GH secretion. 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.
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.