1, the concept of acromegaly Growth hormone (GH) adenoma (or mixed adenoma mixed with other hormones) patients GH overproduction, clinical appear hands and feet, head, thorax and limbs progressive enlargement, hand and foot palm hypertrophy, finger thickening, distal end spherical, forehead bulge, orbital, cheekbone and jaw obvious protrusion, widening of the gap between the teeth, dental bite misalignment, thickening of the lips, wide and flat nose, ear (hat The group of manifestations such as rough, sagging, oily and sweaty skin, hyperpigmentation, sleep apnea, hypertension, diabetes mellitus, colon polyps, and skin redundancy are clinically referred to as acromegaly. Although the diagnosis of acromegaly is not difficult, many patients do not present to the hospital until 7 to 8 years after the onset of symptoms. Patients with acromegaly will die prematurely if they do not receive treatment, and the cause of death is mostly cardiovascular disease. Therefore, early consultation, definitive diagnosis and early treatment are key to reducing the risk of disease and early mortality. The way to reduce the risk of early death is to reduce the blood GH level to normal as soon as possible. 2. Diagnosis of acromegaly Excessive GH can cause an increase in serum insulin-like growth factor (IGF-1) levels, and there is no sufficient decrease in serum GH levels after oral glucose administration (glucose tolerance test). Serum IGF-1 levels correlate with the patient’s age and gender. GH secretion and serum IGF-1 concentrations decrease with age and are higher in women than in men. IGF-1 level testing is a useful method to screen for patients with suspected acromegaly. Pituitary GH adenomas may not manifest early in the course of acromegaly, but may be accompanied by excessive production of lactogen, manifesting as overflow, menstrual disorders and hyperprolactinemia, and should be screened for acromegaly in such young women. Confirmation of the diagnosis of acromegaly is indicated by a rise in IGF-1 concentration and a serum GH level >1.0ng/ml (ug/L) even after 75g or 100g of oral glucose (2.5mU/L). Oral glucose tolerance test: Blood GH levels were measured every half hour (5 blood samples) before and 2 hours after the start of glucose ingestion. Patients should undergo pituitary MRI after definite GH elevation. Most patients with acromegaly have pituitary macroadenomas and some patients have microadenomas. Treatment of acromegaly The first treatment for acromegaly is surgical removal of the adenoma by a neurosurgeon experienced in pituitary surgery, the outcome of which depends on the experience and expertise of the neurosurgeon. Although pituitary macroadenomas, especially when the tumor invades the cavernous sinus or bone structures, are almost impossible to cure by surgical means alone, surgical removal of part of the lesion is still needed to relieve pressure on the visual pathway to avoid loss of vision and to set the stage for the next step of radiotherapy. The surgical cure rate is 50-70%. A significant number of patients still need other adjuvant treatment. 4. Postoperative evaluation Because of the short half-life of GH (only 19 min), an oral glucose tolerance test can be performed in the early postoperative period (within 1 week) to check whether the blood GH level is <1.0ng/ml (ug/L) (2.5mU/L). In contrast, IGF-1 concentration decreases slowly and must be measured after 3 months to be accurate and reliable. If the blood IGF-1 level reaches the level matching with normal age and gender is the most ideal result of treatment. 5.Medication Current useful medication includes dopamine agonists and growth inhibitor analogues. Dopamine agonists such as bromocriptine (15-40mg/d orally, not effective in all patients; bromocriptine sensitivity test: better in those with >50% decrease in GH) can provide symptomatic relief in 90% of patients, but only less than 20% of patients will have blood IGF-1 in the normal range. Growth inhibitors are only effective when administered intravenously on a continuous basis. Growth inhibitor analogs, including octreotide and santoprene (20mg/28d, intramuscular), are effective when administered subcutaneously or intramuscularly. These drugs not only improve symptoms in 90% of patients, but also lower blood GH and IGF-1 to normal levels in 50%-60% of patients. However, the drugs are expensive. A newly developed GH antagonist, Pegvisomant, has been reported to suppress blood IGF-1 to normal levels in 89% of 112 patients on 20 mg/d of subcutaneous injection by the patients themselves. It has also been reported that 90% of 90 patients who were treated for more than 12 months achieved normal serum IGF-1 concentrations. After dosing, blood GH levels increased and reached a plateau level at about 6 months. In this study, 2 patients had enlarged pituitary adenomas and the rest had no change in tumor size. This drug is currently the most effective. 6.Radiation therapy Pituitary radiation therapy should be used as an adjuvant treatment for postoperative residual lesions. Because radiation therapy usually takes months to years to bring GH and IGF-1 down to normal levels, patients should be given medication while waiting for radiation therapy to take effect. In recent years, it has been reported that gamma knife treatment is more effective than normal radiotherapy. The side effects of radiotherapy include progressive hypopituitarism and reduced secretion of some or all pituitary hormones; the earliest and most common deficiency is gonadotropin (LH,FSH) and secondary hypogonadism. At 4 years of follow-up, gonadotropin deficiency has been reported in 67%, ACTH deficiency in 67%, and TSH deficiency in 55%. Patients receiving pituitary radiation therapy should be followed up regularly (at least every 6 months) with hormone level testing and replacement therapy if necessary. In conclusion, from a therapeutic point of view, surgical treatment is the first consideration, and transsphenoidal sinus surgery is the preferred method. Neuroendoscopic transsphenoidal surgery has more advantages than the conventional surgical microscopic transsphenoidal sinus surgery: less trauma, faster recovery, safer and more complete tumor removal, less postoperative discomfort for the patient, and no increase in treatment cost. Endoscopic transsphenoidal resection of pituitary tumors for acromegaly has become a trend of treatment at home and abroad.