Outcome of surgical intrasellar growth hormone tumor performed by a pituitary specialist surgeon in a developing country

Gondim, Jackson; Ferraz, Tânia; Mota, Ítalo; Studart, Dayse; Almeida, João Paulo; Gomes, Eymeric; Schops, Michele

doi:10.1016/j.surneu.2008.02.012

Cited by 20 publications

(21 citation statements)

References 20 publications

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“…Treatment options for acromegaly include surgery, medical therapy, and radiotherapy. Surgery is the first choice of treatment for GH-secreting adenomas due to rapid control of GH/IGF-I levels and lower costs (13,14). Conventionally, transsphenoidal microsurgery has been considered the best surgical approach for most pituitary adenomas such as GH secreting adenomas (12, 13,30).…”

Section: Introductionmentioning

confidence: 99%

“…Surgery is the first choice of treatment for GH-secreting adenomas due to rapid control of GH/IGF-I levels and lower costs (13,14). Conventionally, transsphenoidal microsurgery has been considered the best surgical approach for most pituitary adenomas such as GH secreting adenomas (12, 13,30). Nowadays, the endoscopic transsphenoidal approach has become an initial option for resection of all pituitary adenomas because of having a lot of advantages such as better illumination, improved visualization, less nasal trauma, increased patient comfort, using angle scopes to reach the parasellar region, and achieving better results on tumor removal (4,13,30).…”

Section: Introductionmentioning

confidence: 99%

“…Conventionally, transsphenoidal microsurgery has been considered the best surgical approach for most pituitary adenomas such as GH secreting adenomas (12, 13,30). Nowadays, the endoscopic transsphenoidal approach has become an initial option for resection of all pituitary adenomas because of having a lot of advantages such as better illumination, improved visualization, less nasal trauma, increased patient comfort, using angle scopes to reach the parasellar region, and achieving better results on tumor removal (4,13,30). In published literatures, biochemical remission rates following surgical intervention for acromegaly range from 34 to 83% (12,17,18,23,27,30,37).…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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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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“…However, the costs of such treatment and the occurrence, in some cases, of major side effects, represent important limitations of the medical therapy. 2,4,12 Surgical treatment, which provides rapid control of GH/IGF-I levels and lower costs, remains, therefore, the first line of treatment for GH-secreting adenomas according to different neuroendocrinology societies and pituitary centers. 12,13 Classically, transsphenoidal microsurgery has been considered the best surgical approach for most GH-secreting adenomas.…”

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confidence: 99%

Pure endoscopic transsphenoidal surgery for treatment of acromegaly: results of 67 cases treated in a pituitary center

Gondim¹,

Almeida

Albuquerque

et al. 2010

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Object Acromegaly is a chronic disease related to the excess of growth hormone (GH) and insulin-like growth factor–I secretion, usually by pituitary adenomas. Traditional treatment of acromegaly consists of surgery, drug therapy, and eventually radiotherapy. The introduction of endoscopy as an additional tool for surgical treatment of pituitary adenomas and, therefore, acromegaly represents an important advance of pituitary surgery in the recent years. The aim of this retrospective study is to evaluate the results of pure transsphenoidal endoscopic surgery in a series of patients with acromegaly who were operated on by a pituitary specialist surgeon. The authors discuss the advantages, outcome, complications, and factors related to the success of the endoscopic approach in cases of GHsecreting adenomas. Methods The authors retrospectively analyzed data from cases involving patients with GH-secreting adenomas who underwent pure transsphenoidal endoscopic surgery at the Department of Neurosurgery of the General Hospital in Fortaleza, Brazil, between 2000 and 2009. Tumors were classified according to size as micro- or macroadenomas, and tumor extension was analyzed based on suprasellar/parasellar extension and sella floor destruction. All patients were followed up for at least 1 year. The criteria of disease control were GH levels < 1 ng/L after oral glucose tolerance test and normal insulin-like growth factor–I levels for age and sex. Results During the study period, 67 patients underwent pure endoscopic transsphenoidal surgery for treatment of acromegaly. Disease control was obtained in 50 cases (74.6%). The rate of treatment success was higher in patients with microadenomas (disease control achieved in 12 [85.7%] of 14 cases) than in those with larger lesions. Suprasellar/parasellar extension and high levels of sella floor erosion were associated with lower rates of disease control (p = 0.01 and p = 0.02, respectively). Complications related to the endoscopic surgery included epistaxis (6.0%), transitory diabetes insipidus (4.5%), and 1 case of seizure (1.5%). Conclusions Endoscopic transsphenoidal surgery represents an effective option for 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. Factors related to the success of the endoscopic surgery are lesion size, suprasellar/parasellar extension, and the degree of sella floor erosion. Although presenting important advantages, there is no conclusive evidence that endoscopy is superior to microsurgery in treatment of GH-secreting adenomas.

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“…The options for acromegaly treatment include medical therapy, surgery, and radiotherapy. The surgical treatment provides rapid control of GH and IGF-1 levels and it is the first line of treatment for GH-secreting adenomas 1,9,10 . In 1893, in England, the first pituitary surgery for acromegaly was performed by Caton and Paul, under the supervision of Sir Victor Horsley 11,12,13 , while the first transnasal resection of a pituitary tumor was performed by Schloffer in 1907 14 .…”

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confidence: 99%

Long term follow-up of growth hormone-secreting pituitary adenomas submitted to endoscopic endonasal surgery

Leopoldo¹,

Leopoldo²,

Santos³

et al. 2017

Arq. Neuro-Psiquiatr.

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ABSTRACT.Objective: The aim of this study was to evaluate the results of the endoscopic transsphenoidal technique for growth hormone (GH)-secreting adenomas. Methods: A retrospective analysis based on medical records of 23 acromegalic patients submitted to endoscopic transsphenoidal surgery. Biochemical control was defined as basal GH < 1ng/ml, nadir GH < 0.4ng/ml after glucose load and age-adjusted IGF-1 normal at the last follow-up. Results: The overall endocrinological remission rate was 39.1%. While all microademonas achieved a cure, just one third of macroadenomas went into remission. Suprasellar extension, cavernous sinus invasion and high GH levels were associated with lower rates of disease control. The most common complication was diabetes insipidus and the most severe was an ischemic stroke. Conclusion: The endoscopic transsphenoidal approach is a safe and effective technique to control GH-secreting adenomas. The transcavernous approach may increase the risk of complications. Suprasellar and cavernous sinus extensions may preclude gross total resection of these tumors.Keywords: acromegaly; growth hormone-secreting pituitary adenoma; endoscopy RESUMO Objetivo: O objetivo do estudo é analisar os resultados da cirurgia de ressecção endoscópica transesfenoidal para adenomas secretores do hormônio do crescimento (GH). Métodos: Revisão retrospectiva baseada em análise de prontuários de 23 pacientes acromegálicos submetidos à cirurgia endoscópica. Remissão foi definida por GH < 1ng/ml, nadir de GH ≤ 0,4ng/ml no teste oral de tolerância a glicose e IGF-1 normal para idade. Resultados: A taxa de remissão endocrinológica foi 39,1%. Enquanto todos microadenomas alcançaram controle hormonal, apenas um terço dos macroadenomas obtiveram remissão. Extensão suprasselar, invasão do seio cavernoso e altos níveis de GH foram associados a menores taxas de controle da doença. A complicação mais comum foi diabetes insipidus e a mais grave foi acidente vascular encefálico isquêmico. Conclusão: A abordagem endoscópica transesfenoidal é segura e efetiva para controle de adenomas hipofisários secretores de GH. A abordagem ao seio cavernoso pode aumentar a morbidade da cirurgia. Extensões suprasselares e no seio cavernoso podem dificultar a ressecção completa e o controle da doença.Palavras-chave: acromegalia; adenoma hipofisário secretor de hormônio do crescimento; endoscopia

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Outcome of surgical intrasellar growth hormone tumor performed by a pituitary specialist surgeon in a developing country

Cited by 20 publications

References 20 publications

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

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

Pure endoscopic transsphenoidal surgery for treatment of acromegaly: results of 67 cases treated in a pituitary center

Long term follow-up of growth hormone-secreting pituitary adenomas submitted to endoscopic endonasal surgery

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