Preoperative medical treatments and surgical approaches for acromegaly: A systematic review

Abstract

Objective: Acromegaly is a condition characterized by an overproduction of growth hormone which infers high morbidity and mortality if left untreated. The objective of this review is to analyse and appraise the current evidence for the generalized use of preoperative medications and the various surgical approaches as described in the literature.

Design: A thorough search from MEDLINE via PubMed, EMBASE, and Cochrane Library has been performed which identified a total of 37 papers.

Conclusion: The preoperative use of somatostatin receptor agonists (SAs) in acromegaly is a controversial topic with current guidelines suggesting against their generalized routine use. Most authors noticed an insignificant long-term remission of acromegaly when given SAs compared with nil preoperative therapy, except for invasive macroadenomas as SAs have been found to reduce the tumour volume and aid towards the total resection of the adenoma. Furthermore, according to the evidence available, endoscopic transsphenoidal surgery is the optimum method for hypophysectomy in terms of its remission and safety profile.

Keywords: acromegaly; perioperative; somatostatin analogues; transsphenoidal surgery.

Figure 1

PRISMA flow diagram indicating included studies [Color figure can be viewed at wileyonlinelibrary.com]

Figure 2

Postoperative overall rate of remission for each group of patients from all the articles discussing about the preoperative medical therapy of patients with acromegaly. Key: * indicates statistically significant difference between the two groups (p < .05); + indicates a long‐term remission; − indicates a short‐term remission.

Figure 3

Amalgamated median rates of remission for patients undergoing endoscopic/microscopic TSS, endoscopic TSS and microscopic TSS from all the cross‐sectional articles discussing about TSS in patients with acromegaly. Each category is then subdivided into “overall”, “microadenoma”, and “macroadenoma” rates of remission. TSS, transsphenoidal surgery. [Color figure can be viewed at wileyonlinelibrary.com]

Figure 4

Amalgamated median percentage of patients with the most frequent postoperative complications, from all the cross‐sectional articles discussing about endoscopic TSS or microscopic TSS of patients with acromegaly. TSS, transsphenoidal surgery; DI, diabetes insipidous. [Color figure can be viewed at wileyonlinelibrary.com]