Transsphenoidal surgery was performed in a single surgeon setting
and was the treatment of first choice from 1977 onward in most patients.
Radiotherapy was used to treat postoperative persistent acromegaly
or prophylactically in some patients with postoperative cure but suspected incomplete tumor removal. Two patients were primarily irradiated.
Conventional radiotherapy was given using a linear accelerator
(8 mEV; total dose, 40 Gy, divided in fractions of 2 Gy) by a rotational
field technique or by a two-field technique in a minority of patients.
None of the patients was treated by stereotactic radiotherapy.
Medical treatment was used as the preferred adjuvant secondary
treatment option since the introduction of the somatostatin analog
octreotide. From the availability of depot preparations of octreotide
(Sandostatin LAR; Novartis Pharma AG, Basel, Switzerland) or lanreotide
(Lanreotide Autogel; Ipsen Biotech, Paris, France), these formulations
are used as primary or secondary treatment option.
Treatment for hypopituitarism was started as necessary, based on the
postoperative or yearly follow-up evaluations. The thyroid and (male)
gonadal axis were assessed by basal hormone measurements, whereas
the adrenal axis was evaluated by CRH stimulation test. In premenopausal
women hypogonadism was diagnosed by oligomenorrhea or
amenorrhea and low gonadotropin levels. In the present study hypopituitarism
was defined as the need for replacement therapy for one or
more axes. Patients in this study were not routinely screened for GH
deficiency.