It is clear that surgery results in a rapid fall in GH levels but, equally, it is not always successful or permanent, particularly in patients with large tumours in whom there is a significant incidence of surgically-induced hypopituitarism and occasional recurrence. In most cases, surgery may be performed via the transsphenoidal route.
Pretreatment of pituitary tumours may cause tumour shrinkage such that the tumour is more readily excised surgically; certainly, surgical results are better with smaller tumours, both in terms of cure rate and the incidence of hypopituitarism.
If surgery is not curative, then external radiotherapy is advised and will eventually be effective in the majority of cases, though it may take several years to be fully effective. In the meantime, either octreotide or bromocriptine can be given to keep GH levels as near normal as possible.
