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

De, P., Rees, Dafydd Aled, Davies, N., John, Robert Anthony, Neal, J., Mills, Richard Graham, Vafidis, Johnathon Anthony, Davies, Jeffrey Stephens and Scanlon, Maurice Francis 2003. Transsphenoidal surgery for acromegaly in Wales: results based on stringent criteria of remission. Journal of Clinical Endocrinology & Metabolism 88 (8) , pp. 3567-72. 10.1210/jc.2002-021822

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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 µg/liter (5 mU/liter), a nadir GH less than 1.0 µg/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 µg/liter (day profile or after oral glucose tolerance test) went into remission, compared with 51% of patients with GH levels above 25 µg/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. Abbreviations: CSF, Cerebrospinal fluid; DI, diabetes insipidus; ES, extrasellar; IS, intrasellar; ITT, insulin tolerance test; OGTT, oral glucose tolerance test; PRL, prolactin; SST, short synacthen test.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Medicine
Subjects: R Medicine > R Medicine (General)
ISSN: 0021-972X
Last Modified: 18 Oct 2017 08:22
URI: http://orca.cf.ac.uk/id/eprint/384

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