Outcome of surgery for acromegaly--the experience of a dedicated pituitary surgeon

Gittoes, Neil

doi:10.1093/qjmed/92.12.741

Cited by 155 publications

(104 citation statements)

References 18 publications

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“…21,22,27,31 The authors of series dedicated to outcomes after the microsurgical treatment of GH-secreting adenomas have described biochemical cure rates after microscopic procedures ranging from 42% to 67%, using the most recent criteria. 3,29,36,40,42,52,63 To assess biochemical cure rates after a purely endoscopic resection, the results typically must be separated from endoscopic series reporting data on all adenomas ( Table 5). In these series, cure rates range from 57% to 100%.…”

Section: Discussionmentioning

confidence: 99%

Outcomes after a purely endoscopic transsphenoidal resection of growth hormone–secreting pituitary adenomas

Campbell¹,

Kenning

Andrews³

et al. 2010

FOC

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Object Using strict biochemical remission criteria, the authors assessed surgical outcomes after endoscopic transsphenoidal resection of growth hormone (GH)–secreting pituitary adenomas and identified preoperative factors that significantly influence the rate of remission. Methods A retrospective review of a prospectively maintained database was performed. The authors reviewed cases in which an endoscopic resection of GH-secreting pituitary adenomas was performed. The cohort consisted of 26 patients who had been followed for 3–60 months (mean 24.5 months). The thresholds of an age-appropriate, normalized insulin-like growth factor–I concentration, a nadir GH level after oral glucose load of less than 1.0 μg/l, and a random GH value of less than 2.5 μg/l were required to establish biochemical cure postoperatively. Results Overall, in 57.7% of patients undergoing a purely endoscopic transsphenoidal pituitary adenectomy for acromegaly, an endocrinological cure was achieved. The mean clinical follow-up duration was 24.5 months. In patients with microadenomas (4 cases) the cure rate was 75%, whereas in patients harboring macroadenomas (22 cases) the cure rate was 54.5%. Cavernous sinus invasion (Knosp Grades 3 and 4) was associated with a significantly lower remission rate (p = 0.0068). Hardy Grade 3 and 4 tumors were also less likely to achieve biochemical cure (p = 0.013). The overall complication rate was 11.5% including 2 incidents of transient diabetes insipidus and 1 postoperative CSF leak, which were treated nonoperatively. Conclusions A purely endoscopic transsphenoidal approach to GH-secreting pituitary adenomas leads to similar outcome for noninvasive macroadenomas compared with traditional microsurgical techniques. Furthermore, this approach may often provide maximal visualization of the tumor, the pituitary gland, and the surrounding neurovascular structures.

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Section: Discussionmentioning

confidence: 99%

Outcomes after a purely endoscopic transsphenoidal resection of growth hormone–secreting pituitary adenomas

Campbell¹,

Kenning

Andrews³

et al. 2010

FOC

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“…The remaining patients underwent computerized tomography, which was not used for the evaluation of tumor volume reduction because of lower definition of the images. Median tumor volume before treatment with OCT LAR was 3.02 cm 3 (0.1-24.5; nZ13; Table 2, basal) and after 6 months of LAR 1.82 cm 3 (0.04-17.0; nZ13; Table 2). The median tumor volume reduction was 32.4% (K18.6 to 67.5) after 6 months of therapy with OCT LAR.…”

Section: Hormonal Response To Treatment With Oct Lar and Correlationsmentioning

confidence: 99%

“…However, around 80% of those tumors are macroadenomas and hormone hypersecretion is controlled only in 46-52% of the patients with noninvasive macroadenomas after surgery (1)(2)(3)(4). For this reason, adjuvant medical treatment is often necessary, preferably with long-acting somatostatin analogs (SA), such as octreotide and lanreotide, which normalize growth hormone (GH) in 48-57% of the patients and insulin-like growth factor-I (IGF-I) in 47-67% (5).…”

Section: Introductionmentioning

confidence: 99%

Quantitative analysis of somatostatin receptor subtypes (1–5) gene expression levels in somatotropinomas and correlation to in vivo hormonal and tumor volume responses to treatment with octreotide LAR

Taboada

Luque

Neto

et al. 2008

European Journal of Endocrinology

162

110

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Objective: To determine whether the somatostatin receptor subtype (SSTR) expression profile correlates with hormonal and tumor volume responses to postsurgical octreotide long acting repeatable (OCT LAR) treatment. Design and methods: Quantitative real-time RT-PCR was used to evaluate the absolute mRNA copy numbers for all five SSTR subtypes in 22 somatotropinomas. Response to OCT LAR was studied by hormone levels (GH and IGF-I) and tumor volume (sella turcica magnetic resonance imaging). Results: SSTR5 was present at the highest level followed by SSTR2, SSTR3, SSTR1, and SSTR4 (2327 (1046-5555), 2098, 97 (0-460), 14 (0-29 480), and 0 (0-652) copies respectively). Positive correlations were found between SSTR2 levels and the percentage decrease of GH and IGF-I after 3 (rZ0.49, P!0.027 and rZ0.49, P!0.029 respectively) and 6 (rZ0.59, P!0.006 and rZ0.58, P!0.008 respectively) months of OCT LAR. A negative correlation was found between SSTR5 mRNA levels and the percentage decrease of GH after 3 months of OCT LAR (rZK0.52, PZ0.016, nZ21). A higher SSTR2/SSTR5 ratio was observed among patients who obtained hormonal control with OCT LAR, when compared with those uncontrolled (2.4 (0.7-10) vs 0.3 (0.1-7.7), PZ0.001). A ROC curve analysis showed a SSTR2/SSTR5 ratio of 1.3 as the best predictor of disease control, with a sensitivity of 88% and a specificity of 92% -area under curve, 0.9. A positive correlation was also found between SSTR2 mRNA levels and the percentage decrease in tumor volume after 6 months of OCT LAR (rZ0.79, PZ0.002, nZ12). Conclusions: Somatostatin receptor subtype 2 mRNA expression levels in somatotropinomas correlate positively with in vivo hormonal and tumor volume responses to OCT LAR. European Journal of Endocrinology 158 295-303

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“…Even in published series, cure rates vary tremendously and an inverse correlation has been found between the number of neurosurgeons operating in one centre and the cure rate (23,26), varying between 37% and 91% for microadenomas (20,27). More patients underwent radiotherapy before 1991 once somatostatin analogues became available.…”

Section: Cause Of Deathmentioning

confidence: 99%

Epidemiology, clinical characteristics, outcome, morbidity and mortality in acromegaly based on the Spanish Acromegaly Registry (Registro Espanol de Acromegalia, REA)

Mestrón

Webb

Astorga

et al. 2004

European Journal of Endocrinology

348

232

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Objective: To undertake a multicentre epidemiological study reflecting acromegaly in Spain. Design: Voluntary reporting of data on patients with acromegaly to an online database, by the managing physician. Methods: Data on demographics, diagnosis, estimated date of initial symptoms and diagnosis, pituitary imaging, visual fields, GH and IGF-I concentrations (requested locally), medical, radiotherapy and neurosurgical treatments, morbidity and mortality were collected. Results: Data were included for 1219 patients (60.8% women) with a mean age at diagnosis of 45 years (S.D. 14 years). Reporting was maximal in 1997 (2.1 cases per million inhabitants (c.p.m.) per year); prevalence was globally 36 c.p.m., but varied between 15.7 and 75.8 c.p.m. in different regions. Of 1196 pituitary tumours, most were macroadenomas (73%); 81% of these patients underwent surgery, 45% received radiotherapy and 65% were given medical treatment (somatostatin analogues in 68.3% and dopamine agonists in 31.4%). Cures (GH values (basal or after an oral glucose tolerance test) , 2 ng/ml, normal IGF-I, or both) were observed in 40.3% after surgery and 28.2% after radiotherapy. Hypertension (39.1%), diabetes mellitus (37.6%), hypopituitarism (25.7%), goitre (22.4%), carpal tunnel syndrome (18.7%) and sleep apnoea (13.2%) were reported as most frequent morbidities; 6.8% of the patients had cancer (breast in 3.1% of the women and colon in 1.2% of the cohort). Fifty-six patients died at a mean age of 60 years (S.D. 14 years), most commonly of a cardiovascular cause (39.4%); mortality was greater in patients given radiotherapy (hazard ratio 2.29; 95% confidence interval 1.03 to 5.08; P ¼ 0.026), and in those in whom GH and IGF-I concentrations were never normal (P , 0.001). Conclusions: This acromegaly registry offers a realistic overview of the epidemiological characteristics, treatment outcome and morbidity of acromegaly in Spain. As active disease and treatment with radiotherapy are associated with an increase in mortality, efforts to control the disease early are desirable.

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Outcome of surgery for acromegaly--the experience of a dedicated pituitary surgeon

Cited by 155 publications

References 18 publications

Outcomes after a purely endoscopic transsphenoidal resection of growth hormone–secreting pituitary adenomas

Outcomes after a purely endoscopic transsphenoidal resection of growth hormone–secreting pituitary adenomas

Quantitative analysis of somatostatin receptor subtypes (1–5) gene expression levels in somatotropinomas and correlation to in vivo hormonal and tumor volume responses to treatment with octreotide LAR

Epidemiology, clinical characteristics, outcome, morbidity and mortality in acromegaly based on the Spanish Acromegaly Registry (Registro Espanol de Acromegalia, REA)

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