The patient has undergone TSS for acromegaly and now has normal IGF-1 and GH levels, as well as suppressed levels of GH after oral glucose administration. How should the patient be monitored?
It appears that the patient is cured, but GH tumors can slowly regrow over years. At the least, measurements of GH and IGF-1 should be repeated every 6 to 12 months. Some physicians measure GH levels after glucose administration as well. Tumor mass should be monitored at intervals with pituitary MRI. The patient also requires an evaluation for colonic neoplasia, as some studies suggest the incidence of premalignant colonic lesions may be increased in acromegaly. In addition, it is important to assess whether the surgery damaged normal pituitary function by evaluating the patient’s thyroid, adrenal, gonadal, and posterior pituitary function. The effects of surgery on visual fields should be assessed, especially if the patient had preoperative defects.