Hello, I am a 57 year old female diagnoised with Acromegaly in 2005 and had a 3 cm tumor de-bulked. I have not yet had any hormone replacement treatment since surgery. In 2012 a 4 mm Rathke's was identified in my pituitary gland, with symptoms of visual distubances and extreme headaches. I was also diagnoised with trigiminal neuralgia. At present my IGF-1 is at 300 and I am awaiting an MRI to determine if the cyst had changed in size, and also to determine if I need to start Sandostatin treatment. What size would the current cyst (Rathke's Cleft) have to be to make me a candidate for surgery. My wish is not to start the Sandostatin injections..as this is a life time commitment and the cost of the drug is not covered by Provincial Health Care within Canada. What could be the medical impact if I choose to wait for surgery and not start the hormone treatment.