The outcome of surgery in 668 patients with acromegaly using current criteria of biochemical ‘cure’

Abstract

Background and aim: The aim of this study was to illustrate the present role of transsphenoidal surgery as primary therapy in GH-secreting adenomas, and to compare the results concerning control of disease with previous series using older criteria of cure. Method: We report on a consecutive series of 688 acromegalic patients treated over a time period of 19 years. Biochemical cure was defined as normalisation of basal GH level, suppression of GH levels to below 1 ng/ml during an oral glucose load and normalisation of IGF-I levels. Of the 506 patients undergoing primary transsphenoidal surgery, a total of 57.3% postoperatively fulfilled the criteria used.Results: The rate of biochemical 'cure' correlated with the magnitude of the initial GH levels, the tumour size and invasion. The overall complication rate was below 2%. Mortality in this series was 0.1% (1 of 688). During a follow-up period of 10.7 years only two recurrences (0.4%) occurred. However, in the patients treated by transcranial surgery and by repeat surgery the cure rate was found to be relatively low (5.2 and 21.3% respectively). Conclusions: These data suggest that surgery remains with very few exceptions the primary treatment of acromegaly for (i) a high cure rate, (ii) low morbidity, (iii) low recurrence rate and (iv) immediate decline of GH. Based on current criteria of cure, recurrences are uncommon. However, cure by surgery alone is improbable in patients harbouring extended, invasive tumours with high secretory activity, in whom further adjuvant treatment is mandatory.

Cabergoline treatment in acromegaly: cons

“…In the cases of intrasellar adenomas, cure of acromegaly can be achieved in *70 % of the patients when surgery is performed by a skilled neurosurgeon; such surgery is associated with low morbidity and very low mortality rates (0.1 %) [7]. However, for patients harboring tumors with extrasellar invasion, who therefore have a low chance of experiencing a surgical cure, medical treatment can be the first option of therapy [1].…”

“…However, because a considerable percentage of patients harbor invasive macroadenomas, many patients will need adjuvant therapy [1,7]. In the critical analysis that evaluated SSA, a large number of patients were evaluated regarding adjuvant treatment (612 patients on octreotide LAR therapy), and normalization of IGF-I was observed in 67 % of these patients [8].…”

Experience with pegvisomant treatment in acromegaly in a single Brazilian tertiary reference center: efficacy, safety and predictors of response

“…Uncontrolled acromegaly is associated with increased morbidity and mortality (2,3). Surgery is the primary treatment in most cases, but approximately half of the patients will not be cured by the surgical procedure and therefore will need adjuvant medical therapy (4,5).…”

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

“…It aims to reduce symptoms, relieve compressive effects, improve acromegalic features, reverse cardiovascular risk and restore life expectancy 5,28 . The advantages offered by the endoscopic technique 3,21,22,28 , which enables the use of different angles to operate, may facilitate resection of invasive lesions and, consequently, increase remission rate. However, the resection of adenomas in the cavernous sinus should be carefully considered due to the risk of neurovascular complications.…”

“…The microsurgical transsphenoidal route has been the main approach for this disease. 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 .…”