| name | endo-postop-imaging-ge12wks |
| description | Recommends performing an imaging study at least 12 weeks after transsphenoidal surgery for acromegaly to visualize residual tumor and adjacent structures, with MRI as the preferred modality. Use this skill when assessing surgical outcomes once adequate postoperative healing has occurred. |
Perform imaging at least 12 weeks after surgery
STEP 1 — Gather Information
Confirm date of transsphenoidal surgery, verify that at least 12 weeks have elapsed, and assess for MRI contraindications (e.g., pacemaker, ferromagnetic implants, severe claustrophobia).
STEP 2 — Rule In / Rule Out
If ≥12 weeks post‑surgery, proceed to step 3; if <12 weeks, delay imaging until the 12‑week mark.
STEP 3 — Classify or Stratify
If MRI is not contraindicated and is available, select MRI pituitary protocol; if MRI is contraindicated or unavailable, select CT of the sella with thin‑section cuts.
STEP 4 — Decide
Order the chosen imaging study to evaluate for residual tumor and parasellar extension.
Clinical Guardrails / Mimics / Pitfalls
Do not obtain imaging earlier than 12 weeks because postoperative gel foam, fat packing, and edema can mimic residual tumor; avoid relying on CT when MRI is feasible due to inferior soft‑tissue contrast; screen for MRI safety hazards before scheduling.
Concrete Clinical Example
A 48‑year‑old woman had endoscopic transsphenoidal resection of a GH‑secreting macroadenoma on March 10. On June 15 (≥12 weeks later) with no MRI contraindications, a dedicated pituitary MRI is performed, showing no residual enhancing lesion.
Source: Acromegaly: An Endocrine Society Clinical Practice Guideline, Endocrine Society, 2014, DOI:10.1210/jc.2014-2700
