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Skinning the Cat

Martin L. Nusynowitz, MD
JAMA. 1975;233(12):1302-1303. doi:10.1001/jama.1975.03260120064027.
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It is generally accepted that acromegalic patients with significant tumor extension require open surgical hypophysectomy to alleviate local pressure effects on extrasellar structures. Since the majority of acromegalics do not have this condition, a variety of "closed" therapeutic modalities have been developed in recent years to directly obliterate the intrasellar adenoma. Among these are supervoltage teletherapeutic irradiation (cobalt 60, Van de Graaff generator), external heavy particle irradiation, brachytherapy with implantation of radioactive isotopes (yttrium 90, gold 198), radiofrequency or ultrasonic ablation, transsphenoidal cryosurgery, and transsphenoidal microsurgical techniques.

Aloia et al1 have outlined the characteristics of the ideal form of therapy for acromegaly: (1) morbidity and mortality less than that of the untreated disease (which is more than twice that expected in the general population), (2) elimination of factors responsible for morbidity and mortality, (3) correction of hypersomatotropism without induction of hypopituitarism, (4) prevention of extrasellar extension, and (5) an


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