Long‐term Results of Transsphenoidal Pituitary Microsurgery in 60 Acromegalic Patients

Abstract

Sixty patients with clinically and biochemically active acromegaly were treated by transsphenoidal surgery. All patients underwent a full assessment of pituitary function both preoperatively and postoperatively; these studies were repeated 6 months after surgery and every year, when possible. The mean follow-up period was 3.3 years (range 0.5-7 years). The GH level normalized in 62% of patients after surgery. A paradoxical reaction of GH to TRH was present in 35 patients before surgery and had normalized in 17 after surgery. Large tumours were associated with higher GH levels than smaller tumours. A prognostic factor in terms of normalization of both the GH level and an eventual paradoxical reaction to TRH or a glucose challenge was a low preoperative GH level. Three out of seven patients with either a positive postoperative TRH test but a normal GH level, or a slightly elevated GH level suffered a biochemical and clinical recurrence and two of them underwent reoperation. In contrast, when the TRH test had normalized (always in association with normal GH levels) no recurrence was found. The impact of surgery on the other pituitary functions was generally slight and the numbers of patients with preoperative and postoperative impairment were about equal. Postsurgical radiation therapy was administered to patients with an elevated GH level, a non-normalized TRH test irrespective of whether the GH level had normalized, or local invasion of the tumour. In 11 out of 17 patients with elevated GH levels after surgery, normalization was achieved by radiation therapy after a mean period of 2.7 years. The incidence of pituitary failure after irradiation appeared to be high; gonadal function in men and the GH reserve function were especially vulnerable. From this study we conclude that in many cases the adenoma can be removed effectively, without compromising the other pituitary functions. However, a substantial number of the patients require additional radiation therapy, leading to an inevitable loss of other pituitary functions.

Twelve months of treatment with octreotide-LAR reduces joint thickness in acromegaly

“…Anecdotal reports suggest that it is at least clinically improved by the suppression of GH secretion (7,8,30,31) but, once a significant build-up of abnormal cartilage has occurred, the control of hormone hypersecretion by any form of treatment is considered unable to arrest the evolution of the disease (30). This may explain the negative findings at the articular or periarticular level reported by some authors (2,4).…”

The Results of Transsphenoidal Surgery for 44 Consecutive Acromegalic Patients.

“…Because the criteria for "cure" in acromegaly have evolved over the last two decades, recent studies have employed more stringent GH values such as < 2.5 ng/ml [15,16], 2 ng/ml [8] or 0.5 ng/ ml [17]. In addition, some authors have used normalization of the postoperative IGF-1 / somatomedin-C level [7,9,17] or normalization of the GH response to TRH, GnRH or oGTT as indicating a satisfactory outcome [8,15].…”

“…In addition, some authors have used normalization of the postoperative IGF-1 / somatomedin-C level [7,9,17] or normalization of the GH response to TRH, GnRH or oGTT as indicating a satisfactory outcome [8,15]. As in our previous findings [18,19], GH response to TRH, GnRH and/or oral glucose administration was restored in all patients whose postoperative mean basal GH level was reduced to < 3 ng/ml, but it still abnormal in all patients whose postoperative mean basal GH level was > 3 ng/ml.…”

Growth Hormone Secreting Pituitary Adenoma: Clinical Aspects and Surgical Outcome

“…4,5 Acromegaly may be caused by a variety of pathological conditions, but GH-secreting pituitary adenomas are by far the most common. 6 The medical literature is rich with reports covering various aspects of this lesion; 4,[7][8][9][10][11][12] however, published data about experiences with this tumor and its management in Saudi Arabia have been lacking entirely. This has prompted us to review all cases of GH-secreting pituitary adenomas which were operated upon in our institution during a period of 10 years and to compare our findings with the relevant data from the literature.…”