Endoscopic transsphenoidal surgery for acromegaly: remission using modern criteria, complications, and predictors of outcome

J Clin Endocrinol Metab. 2011 Sep;96(9):2732-40. doi: 10.1210/jc.2011-0554. Epub 2011 Jun 29.

Abstract

Context: Despite the growing application of endoscopic transsphenoidal surgery (ETSS), outcomes for GH adenomas are not clearly defined.

Objective: We reviewed our experience with ETSS with specific interest in remission rates using the 2010 consensus criteria, predictors of remission, and associated complications.

Design and setting: This was a retrospective single institution study. PATIENTS, INTERVENTIONS, AND OUTCOME MEASURES: Sixty acromegalic patients who underwent ETSS were identified. Remission was defined as a normal IGF-I and either a suppressed GH less than 0.4 ng/ml during an oral glucose tolerance test or a random GH less than 1.0 ng/ml.

Results: Remission was achieved in all 14 microadenomas and 28 of 46 macroadenomas (61%). Tumor size, age, gender, and history of prior surgery were not predictive on multivariant analysis. In hospital postoperative morning GH levels less than 2.5 ng/ml provided the best prediction of remission (P < 0.001). Preoperative variables predictive of remission included Knosp score (P = 0.017), IGF-I (P = 0.030), and GH (P = 0.042) levels. New endocrinopathy consisted of diabetes insipidus in 5%, adrenal insufficiency in 5.4%, and new hypogonadism in 29% of men and 17% of women. However, 41% of hypogonadal men had normal postoperative testosterone levels and 83% of amenorrheic women regained menses. The most common complaints after surgery were sinonasal (36 of 60, 60%) resolving in all but two.

Conclusions: ETSS for GH adenomas is associated with high rates of remission and a low incidence of new endocrinopathy. Despite the panoramic views offered by the endoscope, invasive tumors continue to have lower rates of remission.

MeSH terms

  • Acromegaly / blood
  • Acromegaly / etiology
  • Acromegaly / surgery*
  • Adenoma / blood
  • Adenoma / complications
  • Adenoma / surgery*
  • Adolescent
  • Adult
  • Aged
  • Female
  • Follow-Up Studies
  • Human Growth Hormone / blood
  • Humans
  • Insulin-Like Growth Factor I / metabolism
  • Male
  • Middle Aged
  • Pituitary Gland / metabolism
  • Pituitary Gland / surgery*
  • Pituitary Neoplasms / blood
  • Pituitary Neoplasms / complications
  • Pituitary Neoplasms / surgery*
  • Remission Induction
  • Retrospective Studies
  • Treatment Outcome

Substances

  • Human Growth Hormone
  • Insulin-Like Growth Factor I