Surgical and non‐surgical interventions for primary and salvage treatment of growth hormone‐secreting pituitary adenomas in adults

Background Growth hormone (GH)‐secreting pituitary adenoma is a severe endocrine disease. Surgery is the currently recommended primary therapy for patients with GH‐secreting tumours. However, non‐surgical therapy (pharmacological therapy and radiation therapy) may be performed as primary therapy or may improve surgical outcomes. Objectives To assess the effects of surgical and non‐surgical interventions for primary and salvage treatment of GH‐secreting pituitary adenomas in adults. Search methods We searched CENTRAL, MEDLINE, WHO ICTRP, and ClinicalTrials.gov. The date of the last search of all databases was 1 August 2022. We did not apply any language restrictions. Selection criteria Randomised controlled trials (RCTs) and quasi‐RCTs of more than 12 weeks' duration, reporting on surgical, pharmacological, radiation, and combination interventions for GH‐secreting pituitary adenomas in any healthcare setting. Data collection and analysis Two review authors independently screened titles and s for relevance, screened for inclusion, completed data extraction, and performed a risk of bias assessment. We assessed studies for overall certainty of the evidence using GRADE. We estimated treatment effects using random‐effects meta‐analysis. We expressed results as risk ratios (RR) for dichotomous outcomes together with 95% confidence intervals (CI) or mean differences (MD) for continuous outcomes, or in descriptive format when meta‐analysis was not possible. Main results We included eight RCTs that evaluated 445 adults with GH‐secreting pituitary adenomas. Four studies reported that they included participants with macroadenomas, one study included a small number of participants with microadenomas. The remaining studies did not specify tumour subtypes. Studies evaluated surgical therapy alone, pharmacological therapy alone, or combination surgical and pharmacological therapy. Methodological quality varied, with many studies providing insufficient information to compare treatment strategies or accurately judge the risk of bias. We identified two main comparisons, surgery alone versus pharmacological therapy alone, and surgery alone versus pharmacological therapy and surgery combined. Surgical therapy alone versus pharmacological therapy alone Three studies with a total of 164 randomised participants investigated this comparison. Only one study narratively described hyperglycaemia as a disease‐related complication. All three studies reported adverse events, yet only on