Modern diagnosis and postoperative monitoring of acromegaly patients at a neurosurgical clinic

Астафьева, Л. И.; Kalinin, Pavel; Кадашев, Б А

doi:10.17116/neiro201780758-62

Cited by 7 publications

(4 citation statements)

References 10 publications

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“…Assim como complicações endócrinas, metabólicas e nos ossos, além das que foram recentemente reconhecidas, que incluem dilatação da aorta e aneurisma cerebral (homens) (7,9,12,15,16) . As principais causas de mortalidade em pacientes com acromegalia são doenças cardíacas, respiratórias e cânceres (17) .…”

Section: Discussionunclassified

Acromegalia: A Importância Do Exame Físico E Diagnóstico Precoce

Franco,

Ciaccio,

Leitzke

2024

Rev. Contemp.

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Objetiva-se, através do presente estudo de caso, descrever e discutir, com base em artigos publicados em revistas científicas indexadas da base de dados eletrônicos do Medline/Pubmed, Scielo, o caso de uma paciente jovem que conviveu por 3 anos com os sintomas de adenoma de hipófise secretor de GH, sem ser diagnosticada. Apresentava sintomas como amenorreia, cefaleia intensa, mudanças físicas aparentes de acromegalia e distúrbios visuais. Tem-se como objetivo também, abordar o tratamento da doença, utilizado para minimizar os sintomas e a conduta cirúrgica proposta. Para a construção do presente relato de caso foi usado materiais clínicos, radiográficos e laboratoriais e uma breve revisão de artigos científicos usando palavras de busca como “pituitary adenoma” e “acromegaly”.

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Section: Discussionunclassified

Acromegalia: A Importância Do Exame Físico E Diagnóstico Precoce

Franco,

Ciaccio,

Leitzke

2024

Rev. Contemp.

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“…12 Stereotactic radiosurgery or EBRT is used only when other treatment options are impossible in an acromegaly patient like absolute contraindication of surgery or when a patient refuses surgery with failure or contraindication or intolerance of medical treatment. 11 Both medical and stereotactic radiosurgeries can be used for residual disease.…”

Section: Introductionmentioning

confidence: 99%

Outcomes in Pituitary Adenoma Causing Acromegaly Following Endoscopic Endonasal Transsphenoidal Surgery

Chhabra

Kumar

Virk

et al. 2022

J Neurosci Rural Pract

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Objectives The objective of this study was the analysis of outcomes after endoscopic endonasal transsphenoidal surgery (EETSS) in acromegaly in terms of surgical complications, clinical improvement, endocrinological remission, achievement of prognostically critical growth hormone (GH) level, and requirement of additional treatment. Materials and Methods The study included 28 acromegaly patients, who underwent EETSS. 2010 consensus criterion was used for defining remission. Assessment of prognostically critical GH level (random value less than 2.5 ng/mL), the extent of resection, and additional treatment was done at postoperative week (POW) 12. Results All adenomas were macroadenomas, with the mean volume of 16.34 cm3 (range, 0.4–99 cm3). Most adenomas had high-grade extensions. Most common suprasellar, infrasellar, anterior, and posterior extension grades were 3 (n = 13), 1(n = 16), 1(n = 14), and 0 (n = 20), respectively. Knosp grade 3 was common on both sides (right, n = 9 and left, n = 8). One patient had already been operated on with EETSS, 1.5 years back from current surgery. Sixteen patients were on hormonal support, preoperatively. Four patients died during follow-up. Postoperative common complications were diabetes insipidus (n = 18), cerebrospinal fluid rhinorrhea (n = 10), surgical site hematoma (n = 3), meningitis (n = 3), hydrocephalus (n = 2), and syndrome of inappropriate antidiuretic hormone (n = 1). The mean hospital stay was 11.62 days, and 12.17 months was the mean follow-up period. At 12 POW, no improvement was seen in body enlargement and visual complaints, but all other complaints improved significantly except perspiration. Adenomas were decreased in all extensions except posterior, and mean adenoma volume was reduced from 16.34 to 2.92 cm3 after surgery. Subtotal resection (STR, n = 10), near-total resection (NTR, n = 7), gross-total resection (GTR, n = 5), and partial resection (PR, n = 2) were achieved. Endocrinological remission and prognostically critical GH levels were attained in 29.17% (n = 7) and 66.67% (n = 16), respectively. NTR, GTR, STR, and PR were associated with 57.14, 40, 10, and 0% endocrinological remission, respectively. Additional treatment was required in a total of 17 patients: 3 GTR, 9 STR, 3 NTR, and 2 PR patients. Ten patients were treated with gamma knife radiosurgery along with medical treatment and seven with medical treatment alone. Conclusion A successful EETSS can reduce adenoma volume to achieve clinical improvement, endocrinological remission, and prognostically critical GH level with some complications related to surgery. Preoperative larger volume and higher extension grades affect these outcomes adversely.

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“…Medical treatment is mainly used to reduce surgical risk from comorbidities, as primary treatment in patients with cavernous sinus invasion without chiasmal compression that cannot be resected completely or in poor surgical candidates. [ 11 ] Stereotactic radiosurgery or EBRT is used only when other treatment options are impossible in an acromegaly patient like absolute contraindication of surgery or a patient refuses surgery with failure or contraindication or intolerance of medical treatment. [ 11 ] Both medical and stereotactic radiosurgery can be used for residual disease.…”

Section: Introductionmentioning

confidence: 99%

“…[ 11 ] Stereotactic radiosurgery or EBRT is used only when other treatment options are impossible in an acromegaly patient like absolute contraindication of surgery or a patient refuses surgery with failure or contraindication or intolerance of medical treatment. [ 11 ] Both medical and stereotactic radiosurgery can be used for residual disease.…”

Section: Introductionmentioning

confidence: 99%

Outcomes in pituitary adenoma causing acromegaly following endoscopic endonasal transsphenoidal surgery

Chhabra

Kumar

Virk

et al. 2022

JNRP

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Objectives: The objectives of the study were to study the analysis of outcomes after endoscopic endonasal transsphenoidal surgery (EETSS) in acromegaly in terms of surgical complications, clinical improvement, endocrinological remission, achievement of prognostically critical growth hormone (GH) level, and requirement of additional treatment. Materials and Methods: The study included 28 acromegaly patients, who underwent EETSS. A 2010 consensus criterion was used for defining remission. Assessment of prognostically critical GH level (random value <2.5 ng/ml), the extent of resection and additional treatment, was done at post-operative week (POW) 12. Results: All adenomas were macroadenomas; with a mean volume of 16.34 cm3 (range, 0.4–99 cm3). Most adenomas had high-grade extensions. Most common suprasellar, infrasellar, anterior, and posterior extension grades were 3 (n = 13), 1 (n = 16), 1 (n = 14), and 0 (n = 20), respectively. Knosp Grade 3 was common on both sides (right, n = 9 and left, n = 8). One patient had already been operated on with EETSS, 1.5 years back from current surgery. Sixteen patients were on hormonal support, preoperatively. Four patients died during follow-up. Post-operative common complications were diabetes insipidus (DI, n = 18), cerebrospinal fluid rhinorrhea (n = 10), surgical site hematoma (n = 3), meningitis (n = 3), hydrocephalus (n = 2), and syndrome of inappropriate antidiuretic hormone (n = 1). The mean hospital stay was 11.62 days and 12.17 months were the mean follow-up period. At 12 POW, no improvement was seen in body enlargement and visual complaints, but all other complaints improved significantly except perspiration. Adenomas were decreased in all extensions except posterior and mean adenoma volume was reduced from 16.34 cm3 to 2.92 cm3 after surgery. Sub-total resection (STR, n = 10), near-total resection (NTR, n = 7), gross-total resection (GTR, n = 5), and partial resection (PR, n = 2) were achieved. Endocrinological remission and prognostically critical GH levels were attained in 29.17% (n = 7) and 66.67% (n = 16), respectively. NTR, GTR, STR, and PR were associated with 57.14%, 40%, 10%, and 0% endocrinological remission, respectively. Additional treatment was required in a total of 17 patients, three in GTR, nine in STR, three in NTR, and two in PR. Ten were treated with Gamma Knife radiosurgery along with medical treatment and seven with medical treatment alone. Conclusion: A successful EETSS can reduce adenoma volume to achieve clinical improvement, endocrinologic remission, and prognostically critical GH level with some complications related to surgery. Pre-operative larger volume and higher extension grades affect these outcomes adversely.

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Modern diagnosis and postoperative monitoring of acromegaly patients at a neurosurgical clinic

Cited by 7 publications

References 10 publications

Acromegalia: A Importância Do Exame Físico E Diagnóstico Precoce

Acromegalia: A Importância Do Exame Físico E Diagnóstico Precoce

Outcomes in Pituitary Adenoma Causing Acromegaly Following Endoscopic Endonasal Transsphenoidal Surgery

Outcomes in pituitary adenoma causing acromegaly following endoscopic endonasal transsphenoidal surgery

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