Gigantism: Microsurgical treatment by transsphenoidal approach and prognostic factors

Abstract

PurposeWe present the results of transsphenoidal microsurgical treatment in 14 patients with gigantism. The influence on the prognosis of factors such as the size and preoperative levels of GH and IGF-1 is also quantified.MethodsThe patients, operated between 1982 and 2004, were reviewed retrospectively in June 2022. All patients had complete endocrinological studies in the preoperative period and a postoperative control between 6 days and 3 weeks. Follow-up has been maintained with annual check-ups between 3 and 31 years. We have compared the preoperative levels of GH and IGF-1 of these patients with the levels of a series of acromegalic patients operated on in the same Center.ResultsIn this series there were 4 women and 10 men. The age ranged between 14 and 21 years. In 6 patients postoperative hormone levels achieve the disease control criteria (42.8%).The CT/MRI study revealed the existence of invasive tumors in 10 of the patients (71.4%). Postoperative CT/MRI showed no tumor tissue in 3 patients and tumor remains in 7. In the other 4 patients, the images were abnormal but not tumorous. A statistical comparison of preoperative serum GH and IGF-1 levels in patients with gigantism and patients with acromegaly demonstrates a significant elevation in the former.ConclusionPituitary adenomas that cause gigantism are usually large and invasive, which makes them difficult to cure. Another factor that makes remission difficult is the existence of levels of GH and IGF-1 secretion that are much higher than those produced in acromegaly.