Results of endoscopic transsphenoidal pituitary surgery in 40 patients with a growth hormone-secreting macroadenoma

Abstract

ObjectiveTranssphenoidal pituitary surgery (TS) is the primary treatment of choice for patients with acromegaly. Macroadenomas (>1 cm) are more difficult to resect than microadenomas (remission rate ± 50% compared to ± 90%). Besides the conventional microscopic TS, the more recently introduced endoscopic technique is nowadays frequently used. However, no large series reporting on its results have yet been published. We evaluated the outcome of endoscopic TS in 40 patients with a growth hormone (GH)-secreting macroadenoma treated in our hospital between 1998 and 2007.MethodsMedical records were retrospectively reviewed. Remission was defined as disappearance of clinical symptoms of acromegaly, normal serum insulin-like growth factor-1 levels (≤2 SD) and serum GH levels suppressed to <2 mU/l after an oral glucose tolerance test within the first 4 months after TS.ResultsIn four patients TS aimed at debulking of the tumour. In the remaining 36 patients, remission was achieved in 20 patients. In the first 5 years remission was achieved in 6 out of 18 patients (33%) compared to 14 out of 22 patients (63%) in the following 5 years (p = 0.06). Thirteen patients had a mild perioperative complication. Before TS 15 patients received hormonal substitution therapy compared to 12 patients (33%) after TS.ConclusionEndoscopic TS is a good primary therapeutic option for patients with a GH-secreting macroadenoma, resulting in a remission rate of up to 63% in experienced hands. This technique can potentially improve the outcome of TS in these patients.

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

“…analysis reached borderline significance levels, suggesting that parasellar and infrasellar extension tend to be independent predictors of persistent disease. On the other hand, in the study by Wagenmakers et al 23 , an invasive tumor did not have significant influence on the remission rate. It was observed in this study that the absence of suprasellar or cavernous sinus invasion were signs of a good prognosis, and there was a tendency for a lower rate of remission, the higher the degree of tumor invasion.…”

“…In this study, the patients were followed on average for 46.9 months, much longer than published in recent studies 1,3,4,5,27 . Only Wagenmakers et al 23 presented long term follow-ups with a mean time of 56 months.…”

“…With CSF (n = 5) values were achieved using old criteria to define a cure 1,3,23 . As shown in recent papers, the best results were achieved in microadenomas (56-100%) compared to macroadenomas (27-71.7%) 1,4,18,28 .…”

“…Recent literature has suggested some helpful predictors for tumor gross resection and endocrine remission are tumor size 3,4,5,11,28 , extension of the lesion 1,3,4,5,11,28 and hormonal levels 4,23,28 . Concerning tumor extension, Campbell et al 3 and Buliman et al 4 evidenced that Knosp grades 3 or 4 were less likely to achieve remission.…”

“…The endoscopic technique is a recent innovation 3,21,22 that allows a panoramic wide angle view to effectively reach supra-and parasellar lesions. Therefore has been suggested that the endoscopic technique may be preferred over the conventional technique, especially in patients with invasive macroadenomas 23,24,25 . The aim of this study was to evaluate the results of the endoscopic transsphenoidal technique for the control of GH-secreting adenomas.…”