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Endonasal Removal of Invasive GH-Secreting Adenoma (Acromegaly)

Endonasal Removal of Invasive GH-Secreting Adenoma (Acromegaly). Acromegaly: Clinical History:. 49 yr man with 10 years of snoring, sleep apnea, coarsened facial features, frontal bossing & prognathism 5 years progressive enlargement of hands & feet 1 year worsening vision

jolie-farley
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Endonasal Removal of Invasive GH-Secreting Adenoma (Acromegaly)

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  1. Endonasal Removal of Invasive GH-Secreting Adenoma (Acromegaly)

  2. Acromegaly: Clinical History: • 49 yr man with 10 years of snoring, sleep apnea, coarsened facial features, frontal bossing & prognathism • 5 years progressive enlargement of hands & feet • 1 year worsening vision • 6 months hypertension & hypercholesterolemia • Hormonal tests: Growth hormone 179 ng/ml (normal < 6); IGF-1 1508 ng/ml, prolactin 184 ng/ml. 1992 1996 2001 2006

  3. Acromegaly: MRI Pre-op MRI shows invasive adenoma with left cavernous sinus and clival invasion. Treated with pre-operative octreotide therapy for 3 weeks then removed by endonasal surgery in near-complete fashion.

  4. Video - Acromegaly

  5. Acromegaly Post-operative course: • Adenoma removed in near-complete fashion. • Post-op GH level decreased from 179 to 1 ng/ml; prolactin 2 ng/ml. • Patient much improved symptomatically but will need additional therapy (octreotide and/or radiotherapy) for remaining tumor in left cavernous sinus & clivus.

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