Acromegaly: The Daily PANCE Blueprint

The answer is B. Surgical resection of the pituitary adenoma

Surgical resection of the pituitary adenoma is considered the most effective initial treatment for most patients with acromegaly. This approach directly removes the tumor, which is usually the source of excess growth hormone production. Surgery has been shown to immediately reduce growth hormone levels and improve symptoms more effectively and quickly compared to medical therapies. Success rates vary, but in experienced hands, surgery can achieve remission in a significant proportion of patients, especially when the adenoma is small and well-defined.

Incorrect Answer Explanations:

• A. High-dose cabergoline – While cabergoline, a dopamine agonist, can be effective in lowering growth hormone levels in some patients, it is generally less effective than surgery and is typically used when surgery is not feasible or in patients with mild disease who prefer medical management.
• C. Radiation therapy to the pituitary – Radiation is considered a third-line treatment or is used in cases where surgery and medication have not been effective. It is not the initial treatment of choice due to the delayed response time and potential long-term side effects, including hypopituitarism.
• D. Octreotide therapy – Octreotide, a somatostatin analog, is effective in lowering growth hormone levels and is often used when surgery is not possible or as adjunct therapy. However, it is not the primary initial treatment due to the need for lifelong therapy and its associated costs and side effects.
• E. Bromocriptine therapy – Bromocriptine is another dopamine agonist but is significantly less effective in the treatment of acromegaly compared to other options. It is rarely used today for this condition due to its lower efficacy and higher side-effect profile compared to newer agents like cabergoline and octreotide.