Transsphenoidal surgery for acromegaly in wales: results based on stringent criteria of remission

J Clin Endocrinol Metab. 2003 Aug;88(8):3567-72. doi: 10.1210/jc.2002-021822.

Abstract

We retrospectively analyzed 90 patients who underwent transsphenoidal surgery (performed by three surgeons) in our center as initial therapy for acromegaly. We used a combination of modern, evidence-based remission criteria including mean day curve GH less than 2.5 micro g/liter (5 mU/liter), a nadir GH less than 1.0 micro g/liter (2 mU/liter) after an oral glucose tolerance test, and normal age-related IGF-I levels (where available). Fifty-seven of 90 (63%) patients remained in remission after surgery. Seventy-nine percent of patients with microadenomas but only 56% of patients with macroadenomas achieved remission (P < 0.001). Eighty-six percent of patients with preoperative GH levels below 10 micro g/liter (day profile or after oral glucose tolerance test) went into remission, compared with 51% of patients with GH levels above 25 micro g/liter at diagnosis (P < 0.002). The remission rate was also related to the period of surgery that was significantly higher in 1998-2001 (76%; P < 0.05) compared with 1990-1997 (54%) and 1980-1989 (63%). There were no recurrences or perioperative deaths. Meningitis occurred in 3% of patients, cerebrospinal fluid rhinorrhea in 7%, and permanent diabetes insipidus in 15%. The proportion of patients who developed new anterior pituitary hormone deficiencies and panhypopituitarism was significantly less in the period 1998-2001 (P < 0.001) when compared with the periods from 1990-1997 and 1980-1989. Transsphenoidal surgery is a safe and effective treatment for acromegaly, and our results compare favorably with those from published series. The presence of an intrasellar lesion and low preoperative GH levels is a good predictor of remission in the long term, but historically in our center this can only be achieved in a significant proportion of patients at the expense of some degree of hypopituitarism. However, surgical outcome in our center, including a reduced frequency of hypopituitarism, has improved significantly over time, coincident with the arrival of a dedicated pituitary neurosurgeon and the use of selective adenomectomy as the preferred surgical approach wherever possible.

MeSH terms

  • Acromegaly / surgery*
  • Adenoma / surgery*
  • Adult
  • Aged
  • Aged, 80 and over
  • Female
  • Glucose Tolerance Test
  • Human Growth Hormone / blood
  • Humans
  • Insulin-Like Growth Factor I / metabolism
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Neurosurgical Procedures* / adverse effects
  • Pituitary Gland / diagnostic imaging
  • Pituitary Gland / pathology
  • Pituitary Gland / surgery*
  • Pituitary Hormones, Anterior / deficiency
  • Pituitary Neoplasms / diagnostic imaging
  • Pituitary Neoplasms / pathology
  • Pituitary Neoplasms / surgery*
  • Postoperative Complications / epidemiology
  • Retrospective Studies
  • Sphenoid Bone / surgery*
  • Tomography, X-Ray Computed
  • Treatment Outcome
  • Wales

Substances

  • Pituitary Hormones, Anterior
  • Human Growth Hormone
  • Insulin-Like Growth Factor I