The Treatment of Acromegaly by Transsphenoidal Surgery

Total body water (TBW) and total potassium (TBK) were measured in patients participating in a follow-up investigation of all acromegalic patients seen between 1956 and 1984. The results were compared with population-based estimates of TBK and TBW calculated from height (BH), weight (BW) age and sex, using data from a large number of healthy subjects (n = 476). The findings were compared with values obtained at diagnosis and were also related to growth hormone (GH) and IGF-I/SmC concentrations at follow-up. BW at follow-up was unchanged compared to BW at diagnosis and was 9.7 and 10.0 kg higher in males and females, respectively, than in healthy subjects of the same BH (BWnorm). Growth hormone concentration at follow-up correlated directly with excess extracellular fluid volume (ECW%) (P less than 0.001) and inversely with the ratio observed/predicted body fat (BF%) (P less than 0.001) as well as with BW/BWnorm (P less than 0.05). On the other hand, GH concentration did not correlate with excess body cell mass (BCM%) estimated from TBK. IGF-I/SmC concentration correlated with GH concentration at follow-up (P less than 0.001) and with ECW% (P less than 0.01) but not with BCM% or BF%. In 39 patients, data on body composition were also available at diagnosis. Of these, three males had developed gonadal insufficiency and their BCM had decreased markedly. One patient had suffered from hemiplegia. Five patients had not received any treatment. In the remaining 30 treated patients, those with a post-treatment GH concentration below 5 mU/l were normalized with respect to ECW and BF. BCM, however, was unchanged. In contrast, patients with GH concentration greater than or equal to mU/l displayed unchanged body composition. Furthermore, BH decreased significantly in successfully treated patients.

Section: Discussionsupporting

confidence: 65%

Body Composition in Acromegaly: The Effect of Treatment

Bengtsson

Brummer

Edén

et al. 1989

“…The definition of 'cure' in acromegaly has been controversial and varies between authors. Many earlier studies relied on basal serum GH determinations and used a postoperative basal GH level <20 mU/l (Wilson, 1984) or 10 mU/l (Tucker et al, 1980;Balagura et al, 1981;Bynke et al, 1983;Tindall & Tindall, 1984;Grisoli et al, 1985;Watanabe et al, 1985;Oyen et al, 1988;Van't Verlaat et al, 1988). In contrast, recent studies have employed lower GH values such as <6 mU/l (Yamada et al, 1989), 5 mU/l (Roelfsema et al, 1985), 4 mU/l (Davis et al, 1993), or even 1 mU/l (Lindholm et al, 1987).…”

Section: Discussionmentioning

confidence: 99%

Retrospective analysis of long‐term surgical results in acromegaly: preoperative and postoperative factors predicting outcome

Yamada¹,

Aiba²,

Takada³

et al. 1996

“…Several groups have reported favourable results in a varying proportion of patients (Hardy et al. 1976;Liidecke et al, 1976;Leavans et al, 1977;U et al, 1977;Faglia et al, 1978;Garcia-Uria et al, 1978;Laws et al, 1979;Arafah er al., 1980;Gubler, 1980;Tucker et al, 1980;Balagura ef al., 1981;Schuster et al, 1981;Baskin el a/.. 1982;Quabbe. 1982: Arosio et d .…”

Section: F Roelfsema Et Almentioning

confidence: 99%

Long‐term Results of Transsphenoidal Pituitary Microsurgery in 60 Acromegalic Patients

Roelfsema

Dulken

Frölich

1985

Sixty patients with clinically and biochemically active acromegaly were treated by transsphenoidal surgery. All patients underwent a full assessment of pituitary function both preoperatively and postoperatively; these studies were repeated 6 months after surgery and every year, when possible. The mean follow-up period was 3.3 years (range 0.5-7 years). The GH level normalized in 62% of patients after surgery. A paradoxical reaction of GH to TRH was present in 35 patients before surgery and had normalized in 17 after surgery. Large tumours were associated with higher GH levels than smaller tumours. A prognostic factor in terms of normalization of both the GH level and an eventual paradoxical reaction to TRH or a glucose challenge was a low preoperative GH level. Three out of seven patients with either a positive postoperative TRH test but a normal GH level, or a slightly elevated GH level suffered a biochemical and clinical recurrence and two of them underwent reoperation. In contrast, when the TRH test had normalized (always in association with normal GH levels) no recurrence was found. The impact of surgery on the other pituitary functions was generally slight and the numbers of patients with preoperative and postoperative impairment were about equal. Postsurgical radiation therapy was administered to patients with an elevated GH level, a non-normalized TRH test irrespective of whether the GH level had normalized, or local invasion of the tumour. In 11 out of 17 patients with elevated GH levels after surgery, normalization was achieved by radiation therapy after a mean period of 2.7 years. The incidence of pituitary failure after irradiation appeared to be high; gonadal function in men and the GH reserve function were especially vulnerable. From this study we conclude that in many cases the adenoma can be removed effectively, without compromising the other pituitary functions. However, a substantial number of the patients require additional radiation therapy, leading to an inevitable loss of other pituitary functions.