Most surgeons rely on a postoperative glucose tolerance test with growth hormone (GH) levels. Unless special arrangements exist most laboratories do not run GH assays every day. As a consequence, the patient has usually been discharged before the results return, because most patients with acromegaly have short in-patient stays. The initial reduction in GH levels to cure or semicure levels (<10 ng/mL, 20 mU/L) often lead to early and significant improvement in the symptoms they had, particularly sweating and carpal tunnel. Even obstructive airway symptoms can ameliorate. Some experts recommend that no decision should be made before the standard 6-wk period has elapsed and the patient retested (Fahlbusch, personal communication).
The decision to reoperate is a tricky one. Clearly, in absolute failure to cure, reoperation is worthwhile, but things are seldom so black and white. Postoperative scanning in a near cure is not usually helpful (3,4). The surgeon often has a feel for whether active tissue is left. When this is not the case, do not operate but reduce GH with somatostatin analogs.
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