ACROMEGALY
Taming Goliath: A surgical revolution in acromegaly treatment
OVERVIEW
Acromegaly is a hormonal disorder in which the pituitary gland produces too much growth hormone. This disorder causes abnormal enlargement of bones and tissues, noticeably in the hands and feet, which occurs gradually over several years.
Enlarged bones in the nose and mouth may cause a large tongue and widely spaced teeth and may lead to sleep apnea. Bone and cartilage growth may lead to arthritis. People with acromegaly can also develop diabetes, high blood pressure, and other problems.
The onset of acromegaly is insidious and seemingly benign, so the signs and symptoms are often ignored or are associated with other more common causes.
By the time an acromegaly patient sees an endocrinologist for diagnosis and treatment, the signs and symptoms have already become very distressing and in some cases permanent. Acromegaly may also lead to a risk of premature mortality.
Early diagnosis and appropriate therapy may lead to reversal and/or prevention of these long-term consequences.
INNOVATION IN SURGICAL TECHNIQUE
Growth-hormone secreting adenomas often invade the medial wall of the cavernous sinus, but this structure is generally not surgically removed because of the risk of vascular and cranial nerve injury. This results on incomplete tumor resections and persistent disease in many patients, with need for long-term medical treatment and/or radiotherapy.
Over the last decade Dr. Fernandez-Miranda has meticulously investigated the medial wall of the cavernous sinus introducing a classification of the parasellar ligaments and their role in anchoring the medial wall, and have developed an innovative technique for selective resection of the medial wall when invaded by tumor.
This pioneering technique has been applied to over 300 patients with all types of pituitary tumors with minimal morbidity and excellent resection and remission rates.
BEST SURGICAL RESULTS EVER REPORTED
The success of surgery for acromegaly is defined by normalization of IGF-1 levels 3 to 6 months after surgery. Multiple surgical series from experienced centers, included ours in 2014, have reported surgical remission rates to vary between 50%-60%. However, after the introduction of the technique for surgical resection of the medial wall of cavernous sinus, the remission rates in the last 30 consecutive patients have improved to over 90%. Even patients with residual tumor after surgery at another center have benefited from the innovative surgical technique achieving surgical remission after a previous unsuccessful surgery. No patients have suffered stroke or permanent double vision, and the need for medical treatment or radiotherapy after surgery has been greatly reduced.
Frequently Asked Questions
What is the success rate for acromegaly surgery? With Dr. Fernandez-Miranda's innovative medial wall resection technique and advanced techniques for cavernous sinus invasion, the surgical remission rate (normalization of IGF-1 levels) has improved to over 90% in the last 60 consecutive patients — the highest rates ever reported in the medical literature. Traditional series report 50–60% remission rates.
Can acromegaly surgery be done through the nose? Yes. Dr. Fernandez-Miranda performs endoscopic endonasal transsphenoidal surgery, a minimally invasive approach through the nose that avoids any external incisions or brain retraction. Most patients go home within 1–2 days after surgery.
Why do acromegaly remission rates vary so much between surgeons? The most common reason for failed acromegaly surgery is unrecognized tumor invasion into the medial wall of the cavernous sinus. Many surgeons lack the technique to safely access this area. Dr. Fernandez-Miranda's pioneering medial wall resection technique specifically addresses this problem, which is why his remission rates are significantly higher than reported averages.
What if my first acromegaly surgery was unsuccessful? Revision surgery is possible. Dr. Fernandez-Miranda has successfully achieved remission in patients who had incomplete tumor removal at other centers, using his specialized technique for medial wall of cavernous sinus resection. A second opinion is strongly recommended before starting lifelong medication.
What happens if acromegaly is not treated? Untreated acromegaly causes progressive enlargement of hands, feet, and facial features, along with serious medical complications including heart disease, diabetes, joint damage, sleep apnea, and increased risk of colon polyps. Early surgical cure prevents these complications and can reverse many symptoms.
Will I need medication after acromegaly surgery? If surgery achieves biochemical remission (normal IGF-1 levels), no medication is needed. With Dr. Fernandez-Miranda's technique achieving over 90% remission rates, the majority of patients do not need long-term medication. For the small percentage who do not achieve complete remission, medical therapy or CyberKnife radiosurgery are available.
How do I get a consultation for acromegaly? Contact Dr. Fernandez-Miranda's office through drjfm.com or Stanford Health Care. Please provide medical records, lab work (GH and IGF-1 levels), and MRI imaging. Your case will be evaluated with a recommendation typically within 24–48 hours. International patients are welcome.
What does a successful acromegaly surgery really look like—and how do patients know they’re in the right hands? In this powerful and deeply human conversation, Tony Alston sits down with Dr. Juan Fernandez-Miranda, (aka Dr. JFM), world-renowned Stanford neurosurgeon and global leader in pituitary and skull base surgery, to unpack what every acromegaly patient deserves to know.
CONTACT US FOR A CONSULTATION OR SECOND OPINION
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Please be ready to provide medical records and imaging studies
Your case will be carefully evaluated and will provide our recommendation and eligibility for surgical intervention