నైరూప్య

Value and consideration of endocrinology in patients.

Karl Fischer

The management of growth-hormone secreting pituitary adenomas is primarily surgical, although failure is common with macro adenomas invading the cavernous sinuses. The advent of endoscopes in skull base surgery has complemented and, in some centers, replaced the traditional microscopic trans sphenoidal approach to adenomectomy in these patients. Despite these innovations, acromegaly remains a difficult disease to cure, with a large proportion of patients requiring adjuvant radiation (RT) or medical therapy for residual tumour. The previous definition of remission was based on criteria formulated in 2000, and this required a nadir GH < 1 ng/ml in addition to normal IGF-1 values when adjusted for age and sex. Following an updated consensus arrived at in 2010, these requirements have been modified, and now interpret a postoperative random GH < 1 ng/ml or a nadir post-suppression GH < 0.4 ng/ml in addition to normalized IGF-1 levels as representative of biochemical remission