Management of Metabolic Acidosis in Growth Hormone-Secreting Tumors

Introduction to Management

The Endocrine Society recommends managing metabolic acidosis in patients with GH-secreting tumors by treating the underlying tumor with transsphenoidal surgery as first-line therapy, while simultaneously correcting the acidosis with alkali therapy, as the acidosis itself creates GH resistance that impairs treatment response 1, 2

The American Association of Neurological Surgeons suggests that transsphenoidal surgery should be performed by an experienced pituitary neurosurgeon as the definitive treatment for the GH-secreting adenoma, even when complete surgical cure appears unlikely, with surgical success rates achieving approximately 50% remission in experienced centers 1, 3
The National Institute of Diabetes and Digestive and Kidney Diseases recommends administering alkali therapy with sodium bicarbonate or citrate solutions to correct the metabolic acidosis while addressing the tumor, targeting plasma bicarbonate normalization (>22 mmol/L) to restore GH receptor sensitivity 2

The Endocrine Society suggests offering monotherapy or combination medical therapy with somatostatin receptor ligands, GH receptor antagonist (pegvisomant), or dopamine agonists for post-operative residual disease, with pegvisomant normalizing serum IGF-1 levels in adequate doses and suppressing growth velocity 1, 3

The American College of Endocrinology recommends evaluating and treating complications of both GH excess and metabolic acidosis, including glucose intolerance, hypertension, hypercalciuria, and hypocitraturia, with metabolic acidosis increasing nephrocalcinosis risk through hypercalciuria and hypocitraturia 2, 5, 6

The Pituitary Society suggests offering pituitary radiotherapy to patients with uncontrolled tumor growth despite incomplete surgical and medical response, except in patients with skull base fibrous dysplasia (McCune-Albright syndrome), with radiotherapy requiring up to 10 years for full GH suppression effect 3