Surgical management of GH-secreting pituitary adenomas: an outcome study using modern remission criteria

J Clin Endocrinol Metab. 2001 Sep;86(9):4072-7. doi: 10.1210/jcem.86.9.7819.


The results of transsphenoidal surgery as initial therapy for GH-secreting pituitary adenomas in 57 acromegalic patients were analyzed retrospectively. Patients with prior surgery or radiation therapy were excluded from the study. Three different criteria were used to define remission: glucose-suppressed (nadir) GH less than 1.0 microg/liter, a normal sex- and age-adjusted IGF-I level, and postoperative random GH levels of 2.5 microg/liter or less. Additionally, we analyzed the neuropathological data, including immunohistochemistry and ultrastructural categorization, and the surgical complications. The short-term remission rate (6-wk postoperative follow-up visit), as determined by a random GH measurement of 2.5 microg/liter or less, was 48.8%; the remission rate, as determined by nadir GH, was 51.4%. For 57 patients followed for 12 months or more after surgery (mean, 37.7 months), surgical remission was achieved in 70.2%, 66.7%, and 61.1%, respectively, for patients assessed by normal IGF-I, random GH, and nadir GH. One patient (1.1%) developed recurrence of active acromegaly 81 months after initially successful surgical therapy. Extrasellar growth of the tumor (P = 0.04) and dural invasion by the adenoma (P = 0.008) were significant univariate predictors of a poor outcome. Tumor size was significantly greater in patients with persistent or recurrent acromegaly (P = 0.02). Patients with tumors of the ultrastructural categories of mixed GH/PRL cell and mammosomatotroph adenomas had the lowest remission rates (50% and 42.9%, respectively). There were no perioperative deaths, and there was no serious morbidity. The permanent complication rate was 3.3% (1 permanent DI and 2 nasal septal perforations). Surgical management of acromegaly currently provides prompt, effective, and satisfactory initial treatment for the majority of patients. Using stringent criteria for remission, primary transsphenoidal surgery for GH-secreting pituitary adenomas is effective and often definitive therapy for acromegaly. These results provide a benchmark for the contemporary results of surgical management as assessed by modern outcome criteria.

MeSH terms

  • Acromegaly / etiology
  • Adenoma / complications
  • Adenoma / metabolism*
  • Adenoma / surgery*
  • Adolescent
  • Adult
  • Aged
  • Eye Diseases / diagnosis
  • Eye Diseases / etiology
  • Female
  • Follow-Up Studies
  • Human Growth Hormone / metabolism*
  • Humans
  • Immunohistochemistry
  • Luminescent Measurements
  • Male
  • Middle Aged
  • Pituitary Neoplasms / complications
  • Pituitary Neoplasms / metabolism*
  • Pituitary Neoplasms / surgery*
  • Retrospective Studies
  • Treatment Outcome


  • Human Growth Hormone