Transsphenoidal surgery for acromegaly: predicting remission with early postoperative growth hormone assays

Sarkar, Sauradeep; Jacob, K. S.; Pratheesh, Ravindran; Chacko, Ari G

doi:10.1007/s00701-014-2098-5

Cited by 36 publications

(27 citation statements)

References 36 publications

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“…In addition, IGF-I is credited with reducing insulin resistance and the blood glucose level (17). One possible explanation for the greater decrease in the glucose level in the DM group is that diabetes patients with a high insulin level can have increased sensitivity of IGF-I receptors (26). Similar to patients with glucose metabolic disorder that is caused only by high GH levels in the blood, the reduction or elimination of GH level can make such patients exhibit enhanced reactivity to IGF-I.…”

Section: Discussionmentioning

confidence: 99%

Correlation analysis between short-term insulin-like growth factor-I and glucose intolerance status after transsphenoidal adenomectomy in acromegalic patients: a large retrospective study from a single center in China

Li¹,

Zhang²,

Guo³

et al. 2019

Archives of Endocrinology and Metabolism

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Objectives: Our study aimed to investigate the associations of glucose tolerance status with insulinlike growth factor-I (IGF-I) and other clinical laboratory parameters of acromegalic patients before and after the patients underwent transsphenoidal adenomectomy (TSA) by conducting a singlecenter, retrospective study. Subjects and methods: A total of 218 patients with acromegaly who had undergone TSA as the first treatment were retrospectively analyzed. Serum IGF-I, growth hormone (GH) and glucose levels were measured before and after surgery. Results: The follow-up levels for random GH, GH nadir, and the percentage of the upper limit of normal IGF-I (%ULN IGF-I) were decreased significantly. The percentages of normal (39.0%), early carbohydrate metabolism disorders (33.0%) and diabetes mellitus (28.0%) changed to 70.2%, 16.5% and 13.3%, respectively, after TSA. %ULN IGF-I at baseline was higher in the diabetes mellitus (DM) group than in the normal glucose tolerance group and impaired glucose tolerance (IGT) /impaired fasting glucose (IFG) groups before TSA, and the DM group exhibited a greater reduction in %ULN IGF-I value after surgery. The follow-up %ULN IGF-I value after surgery was significantly lower in the improved group, and Pearson's correlation analysis revealed that the reductions in %ULN IGF-I corresponded with the reductions in glucose level. Conclusion: This study examined the largest reported sample with complete preoperative and follow-up data. The results suggest that the age-and sex-adjusted IGF-I level, which reflects altered glucose metabolism, and the change of it are associated with improved glucose tolerance in acromegalic patients both before and after TSA.

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Section: Discussionmentioning

confidence: 99%

Correlation analysis between short-term insulin-like growth factor-I and glucose intolerance status after transsphenoidal adenomectomy in acromegalic patients: a large retrospective study from a single center in China

Li¹,

Zhang²,

Guo³

et al. 2019

Archives of Endocrinology and Metabolism

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“…Although early postoperative measurement of GH level can be a good predictor of cure, no obvious cut-off level has been identified. 61,62 Conversely, IGF-1 may take several months to normalize even in patients who are completely cured. 63 Serum GH and IGF-1 should be measured 12 weeks after surgery or later.…”

Section: Special Situations: Acromegaly Management After Primary Surgerymentioning

confidence: 99%

Current best practice in the management of patients after pituitary surgery

Prete

Corsello

Salvatori

2017

Therapeutic Advances in Endocrinology

105

107

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Sellar and parasellar masses are a common finding, and most of them are treated surgically via transsphenoidal approach. This type of surgery has revolutionized the approach to several hypothalamic-pituitary diseases and is usually effective, and well-tolerated by the patient. However, given the complex anatomy and high density of glandular, neurological and vascular structures in a confined space, transsphenoidal surgery harbors a substantial risk of complications. Hypopituitarism is one of the most frequent sequelae, with central adrenal insufficiency being the deficit that requires a timely diagnosis and treatment. The perioperative management of AI is influenced by the preoperative status of the hypothalamic-pituitary-adrenal axis. Disorders of water metabolism are another common complication, and they can span from diabetes insipidus, to the syndrome of inappropriate antidiuretic hormone secretion, up to the rare cerebral salt-wasting syndrome. These abnormalities are often transient, but require careful monitoring and management in order to avoid abrupt variations of blood sodium levels. Cerebrospinal fluid leaks, damage to neurological structures such as the optic chiasm, and vascular complications can worsen the postoperative course after transsphenoidal surgery as well. Finally, long-term follow up after surgery varies depending on the underlying pathology, and is most challenging in patients with acromegaly and Cushing disease, in whom failure of primary pituitary surgery is a major concern. When these pituitary functioning adenomas persist or relapse after neurosurgery other treatment options are considered, including repeated surgery, radiotherapy, and medical therapy.

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“…Вместе с тем в литературе обсуждается вопрос информативности определения уровня ГР в раннем послеоперационном периоде с целью прогнозирования исходов хирургического лечения акромегалии [2, 6,7]. В ряде исследований показано, что низкий уровень ГР в ранние сроки после операции может использоваться как предиктор ремиссии акромегалии, однако оптимальное время забора крови и пороговое значение показателя на настоящий момент окончательно не определены [8][9][10][11][12].…”

Section: ââåäåíèåunclassified

“…В нашем исследовании низкий уровень ГР в ранние сроки после хирургического лечения продемонстрировал лучшую прогностическую значимость: показатель <1,30 нг/мл через 24 ч после операции ассоциирован с ремиссией акромегалии с чувствительностью 96,2% и специфичностью 84,2%. Возможность использования низкого уровня ГР в раннем послеоперационном периоде для прогнозирования ремисии акромегалии подтверждена другими авторами [8][9][10][11]. В крупном исследовании с участием 194 пациентов после транссфеноидального удаления соматотропиномы показано, что наилучшим прогнозом обладал показатель ГР<1,0 нг/мл, который ассоциирован с ремиссией в 92% случаев при оценке через 3 года после операции [8].…”

Section: îáñóAeäåíèåunclassified

“…: все пациенты в их исследовании с уровнем ГР≤1,0 нг/мл достигли ремиссии [10]. В другом исследовании оптимальный уровень ГР≤3,66 нг/мл через 24 ч после операции оказался оптимальным пороговым значением для прогнозирования ремиссии акромегалии через 3 мес после хирургического лечения с чувствительностью 93,1% и специфичностью 79,2% [11]. Ряд авторов изучали также прогностическую значимость определения ГР в первые часы после оперативного лечения [8,9].…”

Section: îáñóAeäåíèåunclassified

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Early postoperative measurement of growth hormone level for prognosis of surgical outcomes in acromegaly

Tsiberkin

Tsoy

Cherebillo

et al. 2020

Terapevticheskii arkhiv

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Aim.To investigate the value of 24 hours post-surgery measurement of growth hormone (GH) level for prognosis of surgical outcomes in acromegaly. Materials and methods.A prospective cohort study included 45 patients with newly diagnosed acromegaly. The degree of parasellar extension was measured on the preoperative sellar magnetic resonance imaging according to the Knosps classification. All patients underwent a transsphenoid adenomectomy performed by one neurosurgeon. Basal GH level was measured at 24 hours after surgery. The efficacy of transsphenoidal adenomectomy evaluated at 12 months after surgery. Results.Acromegaly remission was achieved in 19 (42%) of 45 patients at 12 months after surgery. Pituitary microadenomas and the absence of paracellular invasion, corresponding to Knosp Grade 02, had low prognostic value for long-term remission due to low sensitivity (31.6%) and low specificity (38.5%), respectively. The highest prognostic value for acromegaly remission was showed for 24 hours post-surgery GH level with cut-off 1.30 ng/ml with sensitivity of 96.2% (95% confidence interval 81.199.8%) and specificity of 84.2% (95% confidence interval 62.494.4%). Conclusion.The study demonstrated the possibility of using GH level at 24 after surgery as a predictor for acromegaly remission. GH level 1.30 ng/ml at 24 hours after surgery showed better predictive value for long-term remission compared with the presence of microadenomas and Knosp Grade 02. The absence of decrease of GH level on the first day after surgery may serve as a reason for more close monitoring of patients in the postoperative period. Further studies in a larger number of observers are required to confirm our findings.

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Transsphenoidal surgery for acromegaly: predicting remission with early postoperative growth hormone assays

Cited by 36 publications

References 36 publications

Correlation analysis between short-term insulin-like growth factor-I and glucose intolerance status after transsphenoidal adenomectomy in acromegalic patients: a large retrospective study from a single center in China

Correlation analysis between short-term insulin-like growth factor-I and glucose intolerance status after transsphenoidal adenomectomy in acromegalic patients: a large retrospective study from a single center in China

Current best practice in the management of patients after pituitary surgery

Early postoperative measurement of growth hormone level for prognosis of surgical outcomes in acromegaly

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