Continuity of care in acromegaly: Detecting and managing recurrence after surgical intervention
More details
Hide details
Department of Family Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, MALAYSIA
Online publication date: 2023-05-21
Publication date: 2023-09-01
Electron J Gen Med 2023;20(5):em511
Acromegaly is a rare disease being followed up by primary care team. It is usually caused by pituitary adenoma and the treatment would be resection of the tumour. But is surgical intervention the end of treatment for acromegalic patient? This case highlighted the continuity of care in a 65-year old gentleman who had been diagnosed acromegaly since the age of 31. He had undergone a transseptal transsphenoidal resection of his pituitary adenoma when he was 45-year-old. Postoperatively, there were still residual growth hormone (GH) and insulin like growth factor (IGF-1) secretions. However, during 20 years follow up after operation, despite the increasing level of GH and IGF-1, the management of acromegaly were neglected as the focus of treatment were shifted towards his other medical problem, which is diabetes and atrial fibrillation. During his latest follow up, his complaint of unspecified headache and expressed his worry regarding the recurrence of his condition. Repeated GH level showed an increase in its level and postulated the possibility of recurrent acromegaly. This case emphasizes the important of recognizing the level of GH and IGF-1 after surgical intervention in order to detect recurrence acromegaly by primary care and early referral to endocrine team.
Maione L, Chanson P. National acromegaly registries. Best Pract Res Clin Endocrinol Metab. 2019;33(2):101264. PMid:30894298.
Kwon O, Song YD, Kim SY, Lee EJ. Nationwide survey of acromegaly in South Korea. Clin Endocrinol (Oxf). 2013;78(4):577-85. PMid:22909047.
Hussein Z, Bidin ML, Alias A, et al. Malaysian consensus statement for the diagnosis and management of acromegaly. J ASEAN Fed Endocr Soc. 2019;34(1):8-14. PMid:33442131 PMCid:PMC7784186.
Katznelson L, Laws ER, Melmed S, et al. Acromegaly: An endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2014;99(11):3933-51. PMid:25356808.
Delemer B, Chanson P, Foubert L, et al. Patients lost to follow-up in acromegaly: Results of the ACROSPECT study. Eur J Endocrinol. 2014;170(5):791-7. PMid:24591552.
Kristof RA, Grote A, Redel L, Neuloh G, Klingmüller D, Schramm J. The common consensus criteria have high predictive values for long-term postoperative acromegaly remission. Acta Neurochir (Wien). 2011;153(1):19-25. PMid:20845050.
Aydin S, Ozoner B, Sahin S, et al. A follow-up study on outcomes of endoscopic transsphenoidal approach for acromegaly. Clin Neurol Neurosurg. 2020;198:106201. PMid:32927330.
Fleseriu M, Biller BMK, Freda PU, et al. A Pituitary Society update to acromegaly management guidelines. Pituitary. 2020;24(1):1-13. PMid:33079318 PMCid:PMC7864830.
Melmed S. The Pituitary. Amsterdam: Elsevier; 2017.
Kilinc F, Pekkolay Z, Gozel N, et al. Evaluation of the metabolic characteristics of patients with acromegaly. J Clin Exp Invest. 2016;6(4):382-6.
Journals System - logo
Scroll to top