Owfrequencyoffamilialpituitarytumors, thesmallsizeofaffectedfamilies,andtheverylowprevalenceof mutationswithinthesefamilies,costlygeneticscreeningisnotyet convincinglywarranted.Accuraterelativelylow-costmeasurement ofserumIGF1levelsiscurrentlythemosteffectivescreeningfor affectedpatientswithGH-secretingpituitarytumors. Acromegaly

Owfrequencyoffamilialpituitarytumors, thesmallsizeofaffectedfamilies,andtheverylowprevalenceof mutationswithinthesefamilies,costlygeneticscreeningisnotyet convincinglywarranted.Accuraterelativelylow-costmeasurement ofserumIGF1levelsiscurrentlythemosteffectivescreeningfor affectedpatientswithGH-secretingpituitarytumors. Acromegaly remedy Severaltreatmentoptionsarecurrentlyavailableforacromegaly (Table2). Surgery ResectionofGH-secretingpituitaryadenomasistechnicallychallengingbecauseoftheanatomicinaccessibilityofthepituitary andbonysellarconfinesandtheproximityofvitalbrainandvascularstructures.Functioningtumormicrofociofteninvadedural spaces,arenotreadilyvisibleatsurgery,andcontinuetosecrete GHaftertumorresection.GH-secretingtumorshaveapropensitytoinvadelaterallyintothecavernoussinus,precludingsafe resection.Tumor-associatedinternalcarotidarterytortuosityand microaneurysmsalsorequiresurgicalcautionandalertness.Over 90 ofresectionsareperformedviaanendonasaltranssphenoidal strategy,oftenwithminimallyinvasiveendoscopictechniques. ComputerizedimageguidanceandintraoperativeMRIcoupled with improvement of microinstrumentation and optics have resultedinsafe,helpful,andminimallytraumaticprocedures whenperformedbyskilledandexperiencedneurosurgeons(S23).…