Make the Diagnosis: Unusual Adenoma

(MedPage Today) -- Case Findings: A 42-year-old male presents with a long history of headaches, impaired vision, and fatigue. He mentions that his wedding ring no longer fits, and he reports joint pain. On physical exam, he has swollen hands and feet, coarse facial features, and partial blindness (bitemporal hemianopsia). After diagnosis with acromegaly secondary to a pituitary macroadenoma, the patient is referred for surgery. However, the patient's IGF-1 concentrations remain elevated following a debulking procedure (the tumor location prevented full resection). What is the best next step for this patient?
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