A 64-year-old woman presented with features of acromegaly. An MR scan showed a pituitary tumour with cavernous sinus extension. She underwent trans-sphenoidal surgery and histology of the pituitary tissue showed numerous cells immunostaining for growth hormone.
Investigations (6 months postoperatively):
MR scan of pituitaryenlarged sella, residual tumour in right cavernous sinus
serum growth hormone (day curve average)3.2 ?g/L (<2)
serum insulin-like growth factor 142.0 nmol/L (3.3C23.3)
What is the most appropriate next step in management?
A . conventional external beam radiotherapy to pituitary region
B . long-acting octreotide
C . pegvisomant
D . repeat trans-sphenoidal surgery
E . watchful waiting
Answer: B