Endoscopic Endonasal Approach to the Growth Hormone-Secreting Pituitary Adenomas: Endocrinologic Outcome in 68 Patients

World Neurosurg. 2018 Sep:117:e259-e268. doi: 10.1016/j.wneu.2018.06.009. Epub 2018 Jun 12.

Abstract

Background: The endoscopic endonasal approach has recently become an acceptable option for resection of all pituitary adenomas. We assessed biochemical outcome of endoscopic endonasal surgery in growth hormone (GH)-secreting adenomas, including remission rate, predictors of remission, and associated complications.

Methods: Sixty-eight consecutive patients with acromegaly who underwent endoscopic endonasal surgery were analyzed prospectively. Tumors were classified according to size, Knosp grade, and Hardy-Wilson classification. Biochemical remission was defined as normal serum insulin-like growth factor 1 level and either a suppressed GH serum level less than 0.4 μg/L during an oral glucose tolerance test or a random GH level less than 1.0 μg/L at least 3 months after surgery.

Results: Total biochemical remission rate was 64.7%. Gross total resection was achieved in 61 of the 68 patients (89.7%). Remission was achieved in 12 of 16 microadenomas (75%) and 32 of 52 macroadenomas (61.5%). Based on univariate logistic regression analysis, preoperative variables predictive of remission were age (P = 0.004), Knosp grade (P = 0.023), and preoperative GH levels (P = 0.042). Three patients (4.4%) experienced postoperative panhypopituitarism, and permanent diabetes insipidus was seen in 4 patients (5.9%). Two patients (2.9%) developed cerebrospinal fluid leaks, which were treated by lumbar puncture in one case and early surgical repair in the other case.

Conclusions: Endoscopic endonasal adenoma resection leads to a high rate of endocrinologic remission in GH-secreting adenomas with a low complication rate. Patients with older age, higher preoperative GH levels, and higher Knosp grades are less likely to achieve remission.

Keywords: Acromegaly; Endoscopic endonasal approach; Growth hormone; Pituitary adenoma.

Publication types

  • Evaluation Study

MeSH terms

  • Adenoma / blood
  • Adenoma / pathology
  • Adenoma / surgery*
  • Adolescent
  • Adult
  • Aged
  • Child
  • Female
  • Growth Hormone / metabolism
  • Growth Hormone-Secreting Pituitary Adenoma / blood
  • Growth Hormone-Secreting Pituitary Adenoma / pathology
  • Growth Hormone-Secreting Pituitary Adenoma / surgery*
  • Humans
  • Insulin-Like Growth Factor I / metabolism
  • Male
  • Middle Aged
  • Natural Orifice Endoscopic Surgery / methods*
  • Neuroendoscopy / methods*
  • Prospective Studies
  • Treatment Outcome
  • Tumor Burden
  • Young Adult

Substances

  • Insulin-Like Growth Factor I
  • Growth Hormone