Efficacy and complications of neurosurgical treatment of acromegaly

Krzentowska-Korek, Anna; Gołkowski, Filip; Bałdys-Waligórska, Agata; Hubalewska‐Dydejczyk, Alicja

doi:10.1007/s11102-010-0273-0

Cited by 28 publications

(36 citation statements)

References 24 publications

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“…Treatment for acromegaly aims at decreasing hormone levels, ameliorating patients' manifestations, and decreasing the local compressive effects of the pituitary adenoma. Surgical treatment remains the first management option for virtually all acromegalic patients, unless the patients refuse to undergo or are too ill to undergo a surgical procedure or prefer the medical option to an operation (6,8,17,18,19,20,21). In agreement with Andersen et al (22), we found that a large proportion were females (57.7%) in GHCPRL group, but no significant difference in sex was observed between the two groups.…”

Section: Discussionsupporting

confidence: 91%

“…Furthermore, we find that the normalization rates of GH and IGF1 are not different between the two groups, but the PRL normalization rates are extremely lower in acromegalic patients with hyperprolactinemia, which indicates that PRL might have no influence on the decline of GH and IGF1 in acromegalic patients with hyperprolactinemia. A number of factors have been suggested as useful predictors of the success of surgery, including tumor size (6,36), preoperative hormone levels (37), and monohormonal status in immunocytochemistry (6). According to the pre-and postoperative MRI results, our findings confirm that the preoperative tumor size is an important factor that affects the result of the operation.…”

Section: Discussionsupporting

confidence: 69%

“…In general, the underlying abnormality in most cases is hypersecretion of GH by the pituitary GH-producing tumors. Nonetheless, about 16-27% of these patients have increased GH and prolactin (PRL) levels (6,7,8). Most of the previous studies focused on some particular aspects of the clinical course of acromegaly and its treatment.…”

Section: Introductionmentioning

confidence: 99%

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The characteristics of acromegalic patients with hyperprolactinemia and the differences in patients with merely GH-secreting adenomas: clinical analysis of 279 cases

Wang

Mou²,

Jiang³

et al. 2012

European Journal of Endocrinology

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Objective: The aim of this study is to evaluate clinical data from a large cohort of acromegalic patients with and without hyperprolactinemia. Design and methods: Between January 2002 and June 2010, a set of data on 279 acromegalic patients undergoing transsphenoidal surgery was available. Based on preoperative GH and prolactin (PRL) levels, patients were divided into GH and GHCPRL groups. A stabilization or a further improvement of postoperative changes in clinical, hormonal, immunohistochemical, and magnetic resonance imaging parameters was observed in all patients throughout the follow-up period. Results: The GH group had significantly more coarse facial features, large hands and feet, hypertension, and diabetes mellitus compared with the GHCPRL group but significantly less menstrual disorders (13.8 vs 54.3%, P!0.001) and galactorrhea (3.1 vs 22.4%, P!0.001). The GH group had a higher age at diagnosis compared with the GHCPRL group (45.6G13.9 vs 40.4G11.4 years, PZ0.001). The GH group had a smaller mean maximal diameter of the adenomas (2.2G0.9 vs 2.6G1.1 cm, PZ0.004). There were no significant correlations between hormone levels and the immunohistochemical results. According to the criteria for hormonal cure of acromegaly, the surgical control rates in the GH and GHCPRL groups were 68.4 and 59.7% respectively (PZ0.187). Tumor size was an important factor that affected the results of the operations. The rates of surgical control in GH and GHCPRL groups were 80.7 and 69.1% respectively (PZ0.037), and the recurrence rates in the two groups were 7.1 and 11.3% respectively (PZ0.185). Conclusions: Compared with patients with merely GH-secreting adenomas, acromegalic patients with hyperprolactinemia are characterized by an earlier onset of disease, lesser acromegalic features, lower GH levels, but larger tumor sizes, whereas in female patients, GH-PRL secreting adenomas are associated with higher incidences of menstrual disorders and galactorrhea.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 69%

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The characteristics of acromegalic patients with hyperprolactinemia and the differences in patients with merely GH-secreting adenomas: clinical analysis of 279 cases

Wang

Mou²,

Jiang³

et al. 2012

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%

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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“…27,34,39 Therapy for acromegaly aims to manage the tumor growth as well as GH hypersecretion and IGF-I levels. The long-term objective, hence, is to reduce the morbidity and mortality rates to comparatively normal rates in the general population.…”

Section: Discussionmentioning

confidence: 99%

Treatment of acromegaly by endoscopic transsphenoidal surgery: surgical experience in 214 cases and cure rates according to current consensus criteria

Hazer

Işık

Berker

et al. 2013

JNS

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Object Acromegaly is a disease that has significant morbidity and mortality related to high levels of growth hormone (GH) and insulin-like growth factor–I (IGF-I), and is usually caused by pituitary adenomas. The goal in this study was to investigate the role of endoscopic transsphenoidal surgery and surgical experience in the treatment of GH adenoma cases in relation to surgical results and hormonal cure rates, and to perform a review of the literature. Methods The authors present a retrospective analysis of 214 GH adenoma cases. Restoration of IGF-I levels to normal for age and sex, suppression of GH levels below 0.4 μg/L on the oral glucose tolerance test, and demonstration of the total removal of the tumor on MRI studies obtained after administration of contrast material at the 3-month postoperative follow-up visit were the criteria for cure. Results In total 214 patients with a mean age of 41.9 ± 12 years (range 17–75 years) and a male/female ratio of 106/108 were enrolled in the study. Cure was achieved in 134 (62.6%) of 214 patients. One hundred sixty-nine patients were primary cases, and of these 109 (64.5%) were cured, whereas 61 patients were previously operated cases and of these 25 (41%) were cured. With a 51.1% decrease in the 1st month postoperatively, IGF-I levels were found to be predictive of cure (74.4% sensitivity and 73.7% specificity). Cut-off values for GH levels in predicting cure for the 1st day, 1st week, and 1st month postoperatively were 2.33, 2.05, and 2.25 μg/L, respectively. The cut-off value for surgical experience was 57 for primary surgeries (58.5% cure rate before this cut-off value compared with 72.6% after it; p = 0.025) and 108 for all operations (45.8% vs 79.4%, p = 0.037). Although 28 patients were found to be in remission according to the criteria in 2000, they were not in remission according to the new consensus criteria. Nine of these cases (32.1%) had random GH levels < 1 μg/L at the 1-year follow-up. The 1-year IGF-I and GH levels in these 28 patients showed no significant difference when compared with the cases defined as cured according to the current criteria. Conclusions In acromegaly treatment, transsphenoidal endoscopic surgery performed by an expert senior surgeon and increased surgical experience are important for higher cure rates. Random GH levels < 2.33 μg/L after the 1st day postoperatively and a > 50% decrease in IGF-I levels after the 1st month postoperatively are predictive of cure. Moreover, there is no urgency for additional therapy in patients with GH levels of 0.4–1 μg/L and MRI sequences showing no tumor at the 3-month follow-up, because for these cases remission can be achieved at the 1-year follow-up.

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Efficacy and complications of neurosurgical treatment of acromegaly

Cited by 28 publications

References 24 publications

The characteristics of acromegalic patients with hyperprolactinemia and the differences in patients with merely GH-secreting adenomas: clinical analysis of 279 cases

The characteristics of acromegalic patients with hyperprolactinemia and the differences in patients with merely GH-secreting adenomas: clinical analysis of 279 cases

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

Treatment of acromegaly by endoscopic transsphenoidal surgery: surgical experience in 214 cases and cure rates according to current consensus criteria

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