Curative Result with Primary Medical Therapy in an Elderly Acromegaly Patient

In acromegaly, transsphenoidal hypophysectomy is the primary treatment of choice. Medical treatment is performed on patients uncontrollable with surgery. Indications for primary medical treatment or medical treatment prior to surgery are limited to patients with macroadenoma with high risk for surgery due to cardiac and respiratory problems. Medical treatment is not applied on patients with microadenoma due to the high chance of cure with surgical option. Seventy-five years-old female patient was admitted in our clinic with complaints of drowsiness, fatigue and growth in hands and feet. Patient’s IGF1level was measured 516 ng/ml (64-188 ng/ml normal range for age and gender) and in the magnetic resonance imaging of the pituitary; an adenoma, 2x2 mm in size, was detected. Octreotide LAR therapy was begun 10 mg per month considering the age of the patient. IGF1 level was measured as 129ng/ml and growth hormone (GH) as 0.65ng/ml (0.06-5 ng/ml normal range) at the end of the third month of treatment. On the MRI carried out in the 9th month of treatment, it was observed that the pituitary was compatible with partial empty sella and no adenoma was determined. In our case of acromegaly with microadenoma, taking into account the age and medical condition of the patient, primary medical therapy was required. Although a low dose of octreotide LAR was implemented, primary medical therapy has been effective in controlling biochemical parameters. Moreover, it was observed that the tumor completely disappeared and is considered a curative result. Therefore, primary medical treatment of acromegaly should be among the options in selected patients with microadenomas.