What is the first-line treatment option for acromegaly?

The first-line treatment for acromegaly is surgical intervention. The primary goal in managing acromegaly, which is often caused by a growth hormone-secreting pituitary adenoma, is the removal of this tumor. Transsphenoidal resection is the most common surgical approach utilized, as it allows for direct access to the pituitary gland and can effectively reduce the levels of growth hormone and resolve many of the symptoms associated with acromegaly.

Surgery not only addresses the tumor but can also lead to improvement in associated complications, including those related to cardiovascular health, glucose metabolism, and quality of life. The immediate reduction of growth hormone levels after surgery is a critical reason why it is considered the first-line treatment.

In contrast, medication therapy is typically considered for patients who are not surgical candidates, refuse surgery, or for those who have residual disease after surgery. Radiation therapy is generally regarded as an adjunct treatment, often used when surgery is not successful or feasible and can take years to achieve maximum efficacy. Observation might be appropriate in certain scenarios where the growth of the adenoma is minimal and not causing significant symptoms, but it is not a primary treatment approach in established cases of acromegaly.