Objective: The aim of this study was to evaluate and to validate the relationship between the early postoperative basal GH level and the long-term surgical treatment outcome of GHproducing pituitary adenoma as well as to present our experience of treating such types of pituitary adenoma in our institute. Materials and Methods:We retrospectively analyzed 103 patients with GH-secreting pituitary adenoma who underwent a surgical treatment between the years 2002 and 2010 in the department of Neurosurgery, University hospital, Damascus.The basal GH level was measured in the first week after surgery.With respect to basal GH levels, the patients were assigned to one of three groups:Group 1: patients with postoperative basal GH levels < 1 ng/mL.Group 2: patients with postoperative basal GH levels between 1-2.25 ng/mL.Group 3: patients with postoperative basal GH levels > 2.25 ng/mL.In every group the hormone activity was monitored postoperatively on a regular basis, the mean follow up duration was approximately 49 months (range 32-96 months). Definitive long term remission of acromegaly was considered to have been achieved when GH levels were less than 1 ng/mL and there was no clinical or magnetic resonance imaging evidence of a persisting disease. Results:The cure rate in Group 1 was 93.75 %, and in Group 2 was 72.72%, whereas in Group 3 all patients presented evidence of tumor residual or recurrence. The overall rate of cure was 45.23%. There was a significant relationship between the early postoperative basal GH concentration and long-term postoperative outcome (p<0.05). Conclusion:The early postoperative basal GH level is a simple and reliable factor that may help with predicting long term surgical outcome of pituitary adenoma.

It is well known that the serious systemic changes in acromegaly resulting from excess GH-secretion, and for that reason, treatment is vital. Trans-sphenoidal adenectomy has typically been the accepted initial treatment of choice for most patients with acromegaly. However, the prediction of postoperative disease activity is a major challenge, and even though different criteria for a cure have been suggested and the relationship between these criteria and long-term disease control is still controversial. According to the criteria for cure of Acromegaly-Consensus, Baseline biochemical parameters for the diagnosis of acromegaly include a fasting or random GH and IGF measurement. If a random GH level is less than 0.4 μg/L and IGF is in the age-and gender-matched normal range, the diagnosis of acromegaly is excluded. If either of these levels is not achieved, a glucose tolerance test should be performed, the GH level should fall to 1 μg/L or less for acromegaly to be excluded.In April 2009, the Acromegaly Consensus Group met to reevaluate and update the guidelines on criteria for cure. These guidelines published in 2010 summarized the latest consensus on the management of acromegaly. Therefore, optimal disease control (i.e. posttreatment remission of acromegaly) is now defined as IGF-I level (determined by a reliable standardized assay) in the age-adjusted normal range and a GH level less than 1.0 μg/liter from a random GH measurement (using an ultrasensitive assay). However, assays do not consistently report these values as reflective of biochemical control. Normalization of IGF-I is the only reliable marker of disease control under pegvisomant.

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