Effectiveness of Secondary Transnasal Surgery in GH-Secreting Pituitary Macroadenomas

Kurosaki, Masamichi; Luedecke, Dieter K.; Abe, Takumi

doi:10.1507/endocrj.50.635

Cited by 30 publications

(18 citation statements)

References 27 publications

(50 reference statements)

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“…Repeated transsphenoidal surgery carries a reported risk of new pituitary axis hormone failures in between 3.6 and 62.5% of cases (30)(31)(32). Patients examined 50 months after CRT require substitutions in 20-50% of previously intact axes (2-4), whereas lower figures (14-23%) are reported after GKR (33, 34 and present study).…”

Section: Adverse Effectsmentioning

confidence: 53%

Gamma knife stereotactic radiosurgery for acromegaly

Vik-Mo¹,

Øksnes²,

Pedersen³

et al. 2007

eur j endocrinol

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Background: Gamma knife radiosurgery (GKR) is an adjuvant treatment for acromegaly if surgery fails to normalize GH hypersecretion. Objective: To examine the effect of GKR on tumor growth and hypersecretion, and to characterize the adverse effect of this treatment. Design: Cross-sectional follow-up study. First, retrospective data pre-and post-GKR were collected. Patients then underwent a predefined survey including radiological, endocrinological, ophthalmological, and neurosurgical evaluation. Setting: Norwegian National Center for gamma knife treatment. Patients: Sixty-one patients treated with GKR for acromegaly. Out of 55, 53 living patients underwent a detailed survey. The mean follow-up was 5.5 years. No patient was lost to follow-up. Results: Tumor growth was stopped in all patients. At 3, 5, and 10 years after GKR, 45, 58, and 86% of patients had normal IGF-I levels. Consecutive hormone value analysis showed that patients receiving GH-suppressive medication had a more rapid decline in hypersecretion than those who did not receive such medication. Evaluated by survey baseline values alone, non-elevated IGF-I and GH levels below 5 mIU/l were found in 38%. GH-suppressive medication was terminated in 16 out of 40 patients following GKR. Nine out of 53 surveyed patients (17%) had normal IGF-I and GH nadir below 2.6 mIU/l at glucose tolerance tests, while not on hormone-suppressive medication. Two patients developed minor visual field defects. Eight patients started hormone substitution therapy during the follow-up period. Conclusion: GKR is an effective adjuvant treatment for residual acromegaly, carrying few side effects.

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Section: Adverse Effectsmentioning

confidence: 53%

Gamma knife stereotactic radiosurgery for acromegaly

Vik-Mo¹,

Øksnes²,

Pedersen³

et al. 2007

eur j endocrinol

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“…The overall endocrinological remission rate was found to be 57.1% (16 of 28 patients) without serious morbidity and no mortality. Kurosaki et al (38) reported even higher remission rates: overall remission 60%, remission in transnasally respectable tumours 81.3%. The absence of major surgical complications and significant endocrinological deterioration of other pituitary functions combined with the possibility of long-term control of the disease supports re-exploration as a treatment option in a number of selected patients with persistent acromegaly.…”

Section: Discussionmentioning

confidence: 93%

The outcome of surgery in 668 patients with acromegaly using current criteria of biochemical ‘cure’

Nomikos

Buchfelder²,

Fahlbusch³

2005

eur j endocrinol

443

283

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Background and aim: The aim of this study was to illustrate the present role of transsphenoidal surgery as primary therapy in GH-secreting adenomas, and to compare the results concerning control of disease with previous series using older criteria of cure. Method: We report on a consecutive series of 688 acromegalic patients treated over a time period of 19 years. Biochemical cure was defined as normalisation of basal GH level, suppression of GH levels to below 1 ng/ml during an oral glucose load and normalisation of IGF-I levels. Of the 506 patients undergoing primary transsphenoidal surgery, a total of 57.3% postoperatively fulfilled the criteria used.Results: The rate of biochemical 'cure' correlated with the magnitude of the initial GH levels, the tumour size and invasion. The overall complication rate was below 2%. Mortality in this series was 0.1% (1 of 688). During a follow-up period of 10.7 years only two recurrences (0.4%) occurred. However, in the patients treated by transcranial surgery and by repeat surgery the cure rate was found to be relatively low (5.2 and 21.3% respectively). Conclusions: These data suggest that surgery remains with very few exceptions the primary treatment of acromegaly for (i) a high cure rate, (ii) low morbidity, (iii) low recurrence rate and (iv) immediate decline of GH. Based on current criteria of cure, recurrences are uncommon. However, cure by surgery alone is improbable in patients harbouring extended, invasive tumours with high secretory activity, in whom further adjuvant treatment is mandatory.

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“…For large macroadenoma as Knosp grade 3 and 4, the objective of surgery is not to cure but to control the serum GH levels with the combination of other modalities [44]. Long-term octreotide-LAR treatment has shown profound endocrinologic effect and tumor volume reduction and may be useful in the preoperative treatment of large macroadenomas [26].…”

Section: Discussionmentioning

confidence: 99%

Short-term Preoperative Octreotide Treatment of GH-secreting Pituitary Adenoma: Predictors of Tumor Shrinkage

et al. 2006

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Abstract. We reviewed the cases of 32 patients with growth hormone (GH)-secreting macroadenoma who underwent short-term octreotide treatment before transsphenoidal surgery to determine which types of adenoma the preoperative treatment were sensitive and whether predictors of tumor shrinkage could be identified. The effects of preoperative octreotide treatment, endocrinologic effect and effect on tumor volume in 32 patients were evaluated retrospectively in relation to tumor features on magnetic resonance images and responses to endocrinologic challenge tests. At a daily dose of 300 mg for 2-3 weeks, octreotide reduced serum GH and insulin-like growth factor-1 (IGF-1) levels to 31.9 % and 51.6% of pretreatment values, respectively, and led to a mean tumor volume of 68% of pretreatment volume in 52% of the patients. The endocrinologic effect and the effect on tumor volume were larger in Knosp grades 0-2 than in Knosp grades 3-4. Tumor shrinkage occurred significantly more often among patients that had a good response to both octreotide and bromocriptine challenge tests. For surgical removal of the tumor, the effect of reducing tumor to 68% of pretreatment volume will be beneficial for the macroadenomas of Knosp grades 1-2. Preoperative short-term octreotide treatment is effective for GH-secreting macroadeomas of Knosp grades 1-2 and a good response to both octreotide and bromocriptine challenge tests is a predictor of subsequent tumor shrinkage. These results will lead to more effective selection of patients for preoperative octreotide treatment.

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Effectiveness of Secondary Transnasal Surgery in GH-Secreting Pituitary Macroadenomas

Cited by 30 publications

References 27 publications

Gamma knife stereotactic radiosurgery for acromegaly

Gamma knife stereotactic radiosurgery for acromegaly

The outcome of surgery in 668 patients with acromegaly using current criteria of biochemical ‘cure’

Short-term Preoperative Octreotide Treatment of GH-secreting Pituitary Adenoma: Predictors of Tumor Shrinkage

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