What treatment do you suggest for this 30 year old man with a residual Growth hormone secreting pituitary adenoma? He was operated [trans-sphenoidal excision] one year back and his GH level is 28 ng/ml. [i dont have pre-op scans, as he was operated elsewhere]
What do you suggest?
1]Re-surgery [What approach?]
2]Radiosurgery [what are the risks of cranial nerve palsies due to proximity to cavernous sinus and optic nerves, What are the chances of hormonal remission? Target includes sella?]
3]Radiotherapy [Is this an acceptable option considering the time to remission?]
