When we first met, Aunt O did not look like she had the typical large limb (acromegaly) appearance, probably due to her tall and straight figure. Aunt O, from last Friday (August 1st) after her daughter contacted me by phone through the “”website””, admission to the hospital, pre-op preparation, to surgery this Tuesday (August 5th), pre-op growth hormone (GH) 59μg/L, the first day after surgery was 0.99μg/L. This morning at the check-in Aunt O said ” My arms and legs have gotten smaller!” I thought to myself, “really that fast?” But as the hormones drop, the “body language” changes are immediate. You will feel the improvement in your skin, joints, hemorrhoids, blood sugar, etc. To see the real change in appearance, in addition to the “beautiful” hormone drop after surgery, you have to wait for the time of change, such as six months to a year later, the person, will become back to the beautiful before the disease! ”If the surgery is good, you will have to change your ID card later.” This is a joke I have made many times with patients with large limbs, but I do see it many times in treatment. Let’s go back to the same old topic: the treatment of limbomegaly. Through the website, patients can choose the “real” one, but not necessarily, because you are not always able to identify the real one, it is up to Bodhisattva to give you a pair of wise eyes. Limb size, in fact, including most other pituitary tumors, is really becoming a surgical disease now. Basically, it can be concluded that “medical assistance is only needed when surgery does not work.” (I’ll write more about this topic in a future blog post.) This leads to the second proposition: finding the best surgeon is the key to what you must do. Remember what Li Ka-shing said? “The first factor that determines the value of real estate is the location, the second is the location, the third is still the location.” I’d like to “tamper” with that to say, “Pituitary tumor, first is surgery, then the rest.” My expression is a bit absolute, but if you look at the various national guidelines for pituitary tumor treatment, most of them appear to be “surgery first” as well. That doesn’t mean I’m against non-surgical options, such as for women with microadenomas who don’t have a childbearing mission, such as tumors that are too clean to cut, such as against over-surgical programs, such as for older patients who don’t present with symptoms.