Any newly diagnosed patient should be referred to a multidisciplinary team experienced in
the treatment of pituitary adenomas. The therapeutic management of acromegaly always requires a
personalized strategy. Normal age-matched IGF-I values are the treatment goal. Transsphenoidal surgery
by an expert neurosurgeon is the primary treatment modality for most patients, especially if there
are neurological complications. In patients with poor clinical conditions or who refuse surgery, primary
medical treatment should be offered, firstly with somatostatin analogs (SSAs). In patients who do not
reach hormonal targets with first-generation depot SSAs, a second pharmacological option with pasireotide
LAR or pegvisomant (alone or combined with SSA) should be offered. Irradiation could be
proposed to patients with surgical remnants who would like to be free from long-term medical therapies
or those with persistent disease activity or tumor growth despite surgery or medical therapy. Since
the therapeutic tools available enable therapeutic targets to be achieved in most cases, the challenge is
to focus more on the quality of life.
Keywords: Acromegaly, pituitary, neurosurgery, somatostatin analogs, cabergoline, pegvisomant, pasireotide, comorbidities,
discrepant, resistant, aggressive, gammaknife.
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