Q:

What are the options for treatment available for this patient?

waelhammad
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2022-11-18
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A 45-year-old lady presents with complaints of a progressive increase in the size of hands and feet and shoe size for past 5 years. The family members have noticed a change in her facial appearance in the form of coarsening of features and her voice has become sonorous. She also has complaints of frequent headaches for past 1 year. She complains of amenorrhea for past 5 years. She also has complaints of joint pains for past 3 years which have become more severe for the past 3 months. She is hypertensive for past 1 year and complaints of grade 2 dyspnea on exertion and her hypertension is controlled on 10 mg of cilnidipine and 40 mg of telmisartan. She is not a known diabetic and has checked her random sugars 1 week back which was normal. She is not on any other medications presently (Fig. 1.1).

What are the options for treatment available for this patient?

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waelhammad
2022-11-18
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This patient should be offered surgery because that can provide complete and early cure and normalization of the growth hormone levels. If the tumor is large then the options of surgical versus initial medical therapy can be discussed with the patient and also cost factor should be discussed if the patient is planning for medical therapy. Appropriate patients can be told about option of radiotherapy. The patient undergoes a transsphenoidal resection of the pituitary tumor and she is given a stress dose of hydrocortisone in view of the preoperative diagnosis of cortisol deficiency.

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