Prognostic factors of biochemical remission after transsphenoidal surgery for acromegaly: a structured review

Agrawal, Nidhi; Ioachimescu, Adriana G.

doi:10.1007/s11102-020-01063-x

Cited by 39 publications

(40 citation statements)

References 100 publications

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“…It is well known that IGF-1 responds linearly to GH concentration only up to a certain level and plateaus at higher GH concentrations ( 28 , 29 ), which may explain why IGF-1 concentration at diagnosis was found to be less predictive for early and long-term remission in our analyses. This finding is consistent with the literature, as in studies evaluating both GH and IGF-1, the predictive value of IGF-1 was lower or similar to preoperative GH levels ( 9 ).…”

Section: Discussionsupporting

confidence: 93%

“…Moreover, tumors invading the cavernous sinus are unlikely to be completely removed. These patients rarely achieve remission as a result of surgery alone and often require medical treatment postoperatively ( 9 , 12-15 , 18-20 ). We should mention that we included 204 (72%) patients who received preoperative medical treatment in our study, which could also influence both random GH and IGF-1 concentrations and tumor size ( 21-23 ).…”

Section: Discussionmentioning

confidence: 99%

“…In the Groningen cohort, IGF-1 concentrations were measured with a radioimmunoassay (RIA) of the Nichols Institute of Diagnostics, San-Juan Capistrano, CA, USA, before 2002 ( 9 ), the Nichols Advantage assay from 2002 to February 2006, the Immulite 2500 (Siemens) assay from 2006 to November 2011, and the Immulite 2000 (Siemens) assay from 2011 to April 2013. Since April 2013, IGF-1 concentrations have been measured with the immunometric IDS-iSYS assay (Boldon, UK).…”

Section: Methodsmentioning

confidence: 99%

“…The presence of cavernous sinus invasion, larger tumor size, and higher preoperative GH levels are consistently associated with lower surgical remission rates in the literature ( 9 ). However, results are discrepant between studies, and cohorts are often small, monocentric, and heterogeneous to draw robust conclusions.…”

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confidence: 99%

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Predictors for Remission after Transsphenoidal Surgery in Acromegaly: A Dutch Multicenter Study

Coopmans

Postma

Wolters

et al. 2021

The Journal of Clinical Endocrinology &Amp; Metabolism

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Context Transsphenoidal surgery (TSS) is the primary treatment of choice in acromegaly. It is important to identify patients in whom surgical cure is not attainable at an early stage, both to inform patients on expected treatment outcome and to select those who are more likely to need additional therapy. Objective To identify predictors for remission after TSS in acromegaly. Design Large multicenter study with retrospective data collection from three tertiary neurosurgical referral centers in the Netherlands. Methods We analyzed clinical data since 2000 from three cohorts (Groningen, Nijmegen and Rotterdam, total n=282). Multivariate regression models were used to identify predictors of early biochemical remission (12 weeks-1 year postoperatively) according to the 2010 consensus criteria, long-term remission (age- and sex normalized IGF-1 and the absence of postoperative treatment until last follow-up) and relative IGF-1 and GH reduction. Results A larger maximum tumor diameter (OR 0.91, 95% CI 0.87–0.96, p≤0.0001) was associated with a lower chance of early biochemical remission. A larger maximum tumor diameter (OR 0.93, 95% CI 0.89–0.97, p=0.0022) and a higher random GH concentration at diagnosis (OR 0.98, 95% CI 0.96–0.99, p=0.0053) were associated with a lower chance of long-term remission. Conclusion Maximum tumor diameter and random GH concentration at diagnosis are the best predictors for remission after TSS in acromegaly.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

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Predictors for Remission after Transsphenoidal Surgery in Acromegaly: A Dutch Multicenter Study

Coopmans

Postma

Wolters

et al. 2021

The Journal of Clinical Endocrinology &Amp; Metabolism

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“…Of note, premenopausal women tended to have larger, more aggressive tumor types and lower remission rates than men [52], suggesting a more aggressive natural history and hence more adverse treatment outcomes in this subset of women. Models that yield much higher predictive values than each individual parameter are being developed [54].…”

Section: What's Newmentioning

confidence: 99%

A Pituitary Society update to acromegaly management guidelines

et al. 2020

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Guidelines and consensus statements ensure that physicians managing acromegaly patients have access to current information on evidence-based treatments to optimize outcomes. Given significant novel recent advances in understanding acromegaly natural history and individualized therapies, the Pituitary Society invited acromegaly experts to critically review the current literature in the context of Endocrine Society guidelines and Acromegaly Consensus Group statements. This update focuses on how recent key advances affect treatment decision-making and outcomes, and also highlights the likely role of recently FDA-approved therapies as well as novel combination therapies within the treatment armamentarium.

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Gigantism: microsurgical treatment by transsphenoidal approach and prognostic factors

Santos

Mateos²,

Morante³

et al. 2022

Pituitary

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Purpose We present the results of transsphenoidal microsurgical treatment in 14 patients with gigantism. The influence on the prognosis of factors such as the tumor size and preoperative levels of GH and IGF-1 is also quantified. Materials and methods The 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 supported 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. Results In this series there were 4 women and 10 men. The age ranged between 14 and 21 years. In 6 patients, postoperative hormone levels achieved the disease control criteria (42.8%). The CT/MRI studies revealed the existence of invasive tumors in 10 of the patients (71.4%). Postoperative CT/MRI showed no tumor tissue in 3 patients but in 7 patients there were tumor remains. The remaining 4 patients had abnormal images although not considered as tumor. A statistical comparison of preoperative serum GH and IGF-1 levels in patients with gigantism and patients with acromegaly showed a significant elevation in the former. Conclusion Pituitary adenomas that cause gigantism are generally large and invasive, which makes them difficult to cure. High preoperative levels of GH and IGF-1 are also factors that decrease remission.

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Prognostic factors of biochemical remission after transsphenoidal surgery for acromegaly: a structured review

Cited by 39 publications

References 100 publications

Predictors for Remission after Transsphenoidal Surgery in Acromegaly: A Dutch Multicenter Study

Predictors for Remission after Transsphenoidal Surgery in Acromegaly: A Dutch Multicenter Study

A Pituitary Society update to acromegaly management guidelines

Gigantism: microsurgical treatment by transsphenoidal approach and prognostic factors

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