title: Aggressive tumors and difficult choices in acromegaly.
abstract: OBJECTIVE
  The current article looks at some of the factors associated with pituitary adenomas displaying unusually aggressive biological and clinical behaviour in patients with acromegaly.
  
  
  METHODS
  This was a retrospective, narrative review of previously published evidence chosen at the authors' discretion and presented from the perspective of a Latin American case study.
  
  
  CONCLUSIONS
  Although most pituitary tumors in acromegalic patients are benign and non-aggressive many can behave more aggressively, compromising local surrounding structures. These lesions tend to respond poorly to somatostatin analogs, have a higher risk of recurrence after surgery and, thus, a worse prognosis. Patients with more aggressive tumors constitute a particular challenge, as they often require several therapeutic approaches and may be difficult to manage, especially when options are restricted due to limited resources.
authors.affiliation: Departamento de Endocrinología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
authors.forename: Carmen A
authors.initials: CA
authors.lastname: Carrasco
authors.forename: Mônica
authors.initials: M
authors.lastname: Gadelha
authors.forename: Marcos
authors.initials: M
authors.lastname: Manavela
authors.forename: Oscar D
authors.initials: OD
authors.lastname: Bruno
mesh_terms: D000172:Acromegaly / Q000188:drug therapy / Q000473:pathology*; D000236:Adenoma / Q000188:drug therapy / Q000473:pathology*; D049912:Growth Hormone-Secreting Pituitary Adenoma / Q000473:pathology*; D019382:Human Growth Hormone / Q000378:metabolism; D006801:Humans; D008297:Male; D009361:Neoplasm Invasiveness; D012189:Retrospective Studies; D013004:Somatostatin / Q000031:analogs & derivatives / Q000191:economics / Q000627:therapeutic use
chemical_list: D019382:Human Growth Hormone; D013004:Somatostatin