----------------------------------------------------------- New Message on Pituitary Chat
----------------------------------------------------------- From: Acro1974 Message 1 in Discussion Hi. I am trying to choose between two treatment approaches for acromegaly. One treatment approach is staying on meds and wait. Another treatment approach is surgery with pituitary transposition followed by gamma knife. During the surgery the neurosurgeon (Dr. Couldwell) will clean tumor from the left part of pituitary, then transpose pituitary away from the border of the left cavernous sinus and stick piece of fat to keep pituitary away. 4-6 weeks later gamma knife radiosurgery will aim residual tumor in the area of the left cavernous sinus (by the way, many doctors do not see obvious invasion of the left cavernous sinus). This transposition will decrease the likelihood of loosing pituitary function (in theory, there is no data on that). Dr. Couldwell originally developed pituitary transposition to save fertility in young women that have residual tumor in cavernous sinus. Here is the link: http://www.aans.org/education/journal/neurosurgical/may03/14-5-11.pdf Currently all my hormones are normal except for low normal testosterone. Gamma knife doctor (Dr.Lunsford) told that in my case the likelihood of IGF-1 normalization will be 70 %. He also quoted his statistics of 20-30 % of hypopituitarism. How valid this statistic is? Can hypopituitarism caused by radiosurgery be underreported? For example, my cortisol is 13.5 with AM reference range 3.4 to 26.9. If after radiosurgery my cortisol goes down to 6, it will still be in the normal range but it will be twice less than my personal normal. Dr.Lunsford said that I dont need surgery with pituitary transposition because gamma knife alone will take care of residual tumor just fine. He wrote regarding surgery with pituitary transposition followed by gamma knife: we do not have any practical clinical experience relative to the therapeutic benefit of this approach, but it makes intuitive sense for some patients. I wonder what he meant by this intuitive sence. Dr.Lunsford also told that for hypopituitarism you just take couple pills a day. Is that so easy? So here are my options: 1. Surgery with pituitary transposition followed by gamma knife with 70 % likelihood of IGF-1 normalisation, 30 % likelihood of loosing some pituitary function, and small likelihood of damage to the vision and some other nerves. 2. Staying on medication and waiting. I currently use Pegvisomant but I will probably have to switch to Sandostatin LAR to prevent tumor growth. If I stay on medication and wait-what do I wait for? New technologies? They talk about new technologies for some time already without observable results. How long will I have to wait for those technologies? I have been on Pegvisomant only several months. Some of my symptoms improved, but fatigue, lack of concentration, sleepiness and apathy remained (some days are better than others). If I stay on medication for acromegaly will I ever feel normal? Can I feel normal if I develop hypopituitarism? And I dont even want to think of possibility of developing hypopituitarism AND having residual acromegaly. What it better-medically treated hypopituitarism or medically controlled acromegaly? Any ideas, suggestions? ----------------------------------------------------------- To stop getting this e-mail, or change how often it arrives, go to your E-mail Settings. http://groups.msn.com/PituitaryChat/_emailsettings.msnw Need help? If you've forgotten your password, please go to Passport Member Services. http://groups.msn.com/_passportredir.msnw?ppmprop=help For other questions or feedback, go to our Contact Us page. http://groups.msn.com/contact If you do not want to receive future e-mail from this MSN group, or if you received this message by mistake, please click the "Remove" link below. On the pre-addressed e-mail message that opens, simply click "Send". Your e-mail address will be deleted from this group's mailing list. mailto:[EMAIL PROTECTED]
