Why Surgery May Not Be a Cure
“Some of these tumors are invasive and difficult to remove in their entirety,” says Lewis Blevins, MD, an endocrinologist at UCSF Health in San Francisco. “The surgeon just can’t get all of the tumor out, so they have persistent or active disease.”
A few factors can reduce the likelihood of a pituitary tumor being completely removed in surgery, says George Stamatiades, MD, PhD, an endocrinologist at Brigham and Women’s Hospital in Boston:
- The tumor is large.
- The tumor extends into surrounding brain structures.
- The tumor is close to critical nerves or arteries.
- The neurosurgeon is inexperienced.
“Growth hormone-secreting tumors can sometimes be large or extend into areas that are difficult to safely access, such as the cavernous sinus, a space next to important nerves and blood vessels behind the eyes,” says Dr. Stamatiades. “In those cases, even a small amount of residual tumor can continue to produce excess growth hormone.”
It’s important to know that certain physical changes caused by acromegaly are likely to persist even if surgery is completely successful, says Dr. Blevins, possibly including bone enlargement, arthritis, and carpal tunnel syndrome.
“Anyone can have persistent symptoms and signs, even those that are cured,” Blevins says. In other words, a cure means that your hormone levels return to normal after your tumor is removed, not that your body will be completely free of signs of acromegaly.
Even if your acromegaly is cured, “Patients with acromegaly require ongoing monitoring for associated comorbidities,” says Stamatiades, which may include sleep apnea, high blood pressure, diabetes, cardiovascular disease, and colon polyps.
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