Acromegaly surgery in Manchester revisited – The impact of reducing surgeon numbers and the 2010 consensus guidelines for disease remission

Wang, Yi Yuen; Higham, Claire; Kearney, Tara; Davis, John R.; Trainer, Peter J; Gnanalingham, Kanna

doi:10.1111/j.1365-2265.2011.04193.x

Cited by 62 publications

(35 citation statements)

References 40 publications

(141 reference statements)

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“…Microadenomas and intrasellar macroadenomas are reported to have a relatively high remission rate, 60-80% (2,13,14,15,16). With increasing adenoma size and invasiveness beyond the sellar boundaries, remission rate gradually decreases (2,13,17,18) and reach almost 0% for giant GH-secreting cell tumors (2), similarly to the surgical results observed for patients included in this study.…”

Section: Discussionsupporting

confidence: 70%

Giant GH-secreting pituitary adenomas: management of rare and aggressive pituitary tumors

Shimon

Jallad

Fleseriu

et al. 2015

European Journal of Endocrinology

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Objectives: Patients with acromegaly usually harbor macroadenomas measuring between 10 and 30 mm in maximal diameter. Giant (adenoma size R40 mm) GH-secreting pituitary tumors are rarely encountered and the aim of this study is to analyze different methods for managing them. Design and methods: We have identified 34 patients (15 men and 19 females) with giant adenomas among 762 subjects (4.5%) with acromegaly in our records, and characterized their clinical characteristics and response to treatment. Results: Mean age at diagnosis was 34.9G12.5 years (range, 16-67 years). Mean adenoma size was 49.4G9.4 mm (range, 40-80 mm); 30 adenomas showed cavernous sinus invasion and 32 had suprasellar extension. Twenty-nine (85%) patients had visual field defects. Mean baseline IGF1 was 3.4G1.8!ULN. All patients except one underwent pituitary surgery (one to three procedures), but none achieved hormonal remission following first surgery. Among the 28 subjects with visual disturbances, 14 recovered post-operatively and 13 improved. Treatment with somatostatin analogs was given to all patients after surgical failure. Six achieved remission, nine others were partially controlled (IGF1!1.5!ULN; 3/9 when combined with cabergoline), and 17 did not respond (two were lost). Nine patients were treated with pegvisomant, alone (nZ4) or in combination with somatostatin analogs (nZ5); five are in remission and two are partially controlled. Pasireotide-LAR achieved hormonal remission in one of the six patients. Currently, after a mean follow-up period of 8.9 years, 17 patients are in biochemical remission, eight are partially controlled, and seven are uncontrolled (two were lost to follow-up). Conclusions: Giant GH-secreting adenomas are invasive, uncontrolled by surgery, and respond poorly to medical treatment. Aggressive multimodal therapy is critical for their management, enhancing control rate and biochemical remission.

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Section: Discussionsupporting

confidence: 70%

Giant GH-secreting pituitary adenomas: management of rare and aggressive pituitary tumors

Shimon

Jallad

Fleseriu

et al. 2015

European Journal of Endocrinology

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“…The main aim in the treatment of acromegaly is the total resection of the tumor if possible, prevention of its recurrence and to restore the normal GH/ IGF-1 levels with the long-term aim of avoiding increased morbidity and mortality associated with uncontrolled serum GH and IGF-1 levels (22,26,28,34).…”

Section: Discussionmentioning

confidence: 99%

“…Hormone replacement therapy was administered, if necessary, to patients with clinical and laboratory evidence of hypopituitarism. At 3 months and 6 months postoperative follow-up, patients were analyzed using remission criteria according to the following 2010 consensus guidelines (34): an IGF-I value within normal range for age and gender and a GH value < 0.4 ng/mL after glucose load or a random GH value < 1.0 ng/mL. Also, patients were defined as being remission when they met surgical criteria: no residual tumor was visualized and total removal of the tumor was confirmed by MRI studies on the 1st postoperative day, and at 3-months and 6-months follow-up.…”

Section: Endocrine Analysismentioning

confidence: 99%

Endoscopic endonasal transsphenoidal treatment for acromegaly: 2010 consensus criteria for remission and predictors of outcomes

Yıldırım¹,

Şahinoğlu²,

Divanlıoğlu³

et al. 2014

Turkish Neurosurgery

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AIm: Acromegaly is a chronic disorder characterized by enhanced growth hormone (GH) secretion and elevated insulin-like growth factor-I (IGF-I) levels, usually caused by pituitary adenomas. In this retrospective study, we reviewed our experience with endoscopic endonasal transsphenoidal surgery (EETS) with in remission rates using the 2010 consensus criteria, predictors of remission and associated complications. mATERIAl and mEThods:The authors retrospectively analyzed data from 56 acromegalic patients who underwent pure EETS. Tumors were classified according to size and suprasellar/parasellar extension. The criteria of remission were GH levels < 1 ng/mL randomly, < 0.4 ng/mL after oral glucose tolerance test and normal IGF-I levels for age and sex within the first 3 and 6 months after surgery. REsulTs:Biochemical remission was achieved in 4 of 5 microadenomas (80%) and in 33 of 51 macroadenomas (64.7%). The total remission rate was 66.1% (37 of 56 adenomas). Age, gender and suprasellar extension did not affect the remission rate. However, cavernous sinus invasion, sphenoid sinus invasion and history of prior surgery were associated with lower rates of disease control.CoNClusIoN: EETS represents an effective and safe option for the treatment of patients with acromegaly. High disease control rates and a small number of complications are some of the most important points related to the technique.KEywoRds: Acromegaly, Endoscopic transsphenoidal surgery, Remission, Predictive factors ÖZ AmAÇ: Akromegali genellikle hipofiz adenomuna bağlı gelişen büyüme hormonu (GH) aşırı salınımı ve yükselmiş insülin benzeri büyüme faktörü-1 (IGF-I) ile karakterize kronik bir hastalıktır. Bu retrospektif çalışmada, 2010 remisyon kriterleri kullanılarak endoskopik endonazal transsfenoidal cerrahi (EETC) ile tedavi edilen akromegali hastalarında remisyon oranı, remisyonu etkileyen faktörler ve ilgili komplikasyonlar sunuldu. yÖNTEm ve GEREÇlER: Pür EETC ile tedavi edilmiş 56 GH salgılayan hipofiz adenomu tanılı hastalar retrospektif olarak incelendi. Adenomlar boyutlarına göre mikro/makroadenom olarak ve suprasellar/parasellar yönelimlerine göre sınıflandırıldı. Hastalığın remisyon kriterleri olarak, rastgele bakılan GH düzeyi < 1 ng/mL, oral glukoz tolerans testi sonrası GH düzeyi < 0,4 ng/mL ve cerrahi sonrası ilk 3-6 ay arasında bakılan IGF-I düzeyinin yaşa ve cinsiyete gore normal olması kabul edildi.BulGulAR: 5 mikroadenomun 4'ünde (%80), 51 makroadenomun 33 (%64,7) ünde remisyon sağlandı. Hastaların tümü incelendiğinde, remisyon oranı 56 hastada 37 (%66,1) olarak bulundu. Yaşın, cinsiyetin ve suprasellar büyümenin remisyon oranlarına etkisinin olmadığı görüldü. Ancak daha önce cerrahi geçirmiş olmak, kavernöz sinüs ve sfenoid sinüs invazyonunun remisyon oranlarını azalttığı saptandı. soNuÇ: EETC, akromegalinin tedavisinde etkili ve güvenli bir yöntemdir. Bu teknikle yüksek başarı ve düşük komplikasyon oranlarına ulaşmak mümkündür.

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“…As a reference, the mean remission rates from primary surgery using Cortina criteria in microadenomas, macroadenomas, and adenomas overall are 80%, 57%, and 64%, respectively. 1,24–26 …”

Section: Treatment Optionsmentioning

confidence: 99%

Management Options for Persistent Postoperative Acromegaly

Mathioudakis

Salvatori

2012

Neurosurgery Clinics of North America

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Acromegaly surgery in Manchester revisited – The impact of reducing surgeon numbers and the 2010 consensus guidelines for disease remission

Cited by 62 publications

References 40 publications

Giant GH-secreting pituitary adenomas: management of rare and aggressive pituitary tumors

Giant GH-secreting pituitary adenomas: management of rare and aggressive pituitary tumors

Endoscopic endonasal transsphenoidal treatment for acromegaly: 2010 consensus criteria for remission and predictors of outcomes

Management Options for Persistent Postoperative Acromegaly

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