Value of early postoperative random growth hormone levels and nadir growth hormone levels after oral glucose tolerance testing in acromegaly

Rotermund, Roman; Burkhardt, Till; Rohani, Zaina; Jung, Roman; Aberle, Jens; Flitsch, Jörg

doi:10.1016/j.ghir.2018.03.002

Cited by 13 publications

(17 citation statements)

References 24 publications

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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].…”

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“…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

“…Подобные результаты показаны R. Rotermund и соавт. : 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].…”

Section: îáñóAeäåíèåunclassified

“…Это позволило обеспечить однородность группы. Нами определено не только пороговое значение уровня ГР для прогнозирования ремиссии акромегалии, но и рассчитаны чувствительность и специфичность показателя, что представлено не во всех исследованиях, посвященных данной проблеме [8,10]. Ограничениями исследования стали небольшое число включенных в исследование пациентов и отсутствие данных по отдаленным исходам хирургического лечения акромегалии более 12 мес.…”

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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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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“…Nadir GH after an OGTT may slightly change over time, from immediately postoperatively to 3 months after NS [8]. A prospective study evaluated the predictive role of random GH and IGF1 on a postoperative day one and nadir GH following an OGTT 2 − 4 days after NS [9]. The authors showed that early determination of IGF1 was not useful for predicting disease state; however, the proposed cut-offs for random GH and nadir GH appeared to demonstrate good positive predictive values for remission but inadequate specificity [9].…”

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confidence: 99%

First but not second postoperative day growth hormone assessments as early predictive tests for long-term acromegaly persistence

Cambria

Beccuti

Prencipe

et al. 2021

J Endocrinol Invest

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Purpose Postoperative assessment of acromegaly activity is typically performed at least 3 months after neurosurgery (NS). Few studies have evaluated the use of early postoperative growth hormone (GH) levels as a test to predict short- and long-term remission of acromegaly. Our objective was to evaluate the diagnostic performance of serum random GH on a postoperative day one (D1-rGH) and two (D2-rGH), particularly in predicting long-term disease persistence. Materials and methods Forty-one subjects with acromegaly who were undergoing NS were enrolled (mean age ± SD 47.4 ± 13.1 years at diagnosis; women 54%; macroadenomas 71%). The final assessment of disease activity was performed one year after NS. ROC curves were used to evaluate the diagnostic performance of D1-rGH and D2-rGH. Results After a 1-year follow-up, the overall remission rate was 55%. ROC analysis identified an optimal D1-rGH cut-off value of 2.1 ng/mL for diagnosing long-term disease persistence (55.6% SE; 90.9% SP). The cut-off point became 2.5 ng/mL after maximizing specificity for disease persistence (yielding a 100% positive predictive value) and 0.3 ng/mL after maximizing sensitivity for disease remission. The optimal D2-rGH cut-off value was 0.6 ng/mL (81.8% SE; 50% SP); the cut-off point became 2.9 ng/mL after maximizing specificity and 0.1 ng/mL after maximizing sensitivity, with no clinical utility. Conclusions D1-rGH could be a highly specific test for the early diagnosis of long-term acromegaly persistence, which is predicted by a value > 2.5 ng/mL with a great degree of certainty. The diagnostic performance of D2-rGH was insufficient. Further research is required to validate these preliminary results prior to modifying the postoperative management of acromegaly.

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Exoscopic vs. microscopic transsphenoidal surgery for Cushing’s disease: a retrospective single-center study on 388 patients

et al. 2022

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BackgroundMicroscopic or endoscopic transsphenoidal surgery represent the standard treatment for Cushing's disease (CD). At our institution a new exoscopic approach was implemented. After proof of the general use for transsphenoidal pituitary surgery, the aim of this study was to compare the exoscopic 4K3D video microscope with the microscopic transsphenoidal surgery for patients with CD. MethodsWe conducted a retrospective analysis on 388 patients with CD treated in our medical center via microscopic transsphenoidal surgery (MTS) between January 2008 and July 2019 or via exoscopic transsphenoidal surgery (ExTS) between May 2019 and May 2021. Parameters investigated included histology, pre-and postoperative MRI with tumor size, pre-and postoperative ACTH and cortisol levels, duration of surgery, perioperative and postoperative complications as well as clinical outcome. ResultsPatients who underwent ExTS in CD experienced a lower incidence of SIADH/Diabetes insipidus (p = 0.0164), a higher rate of remission (p = 0.0422) and a shorter duration of surgery (p < 0.0001) compared to MTS. However, there was no signi cant difference regarding new postoperative pituitary insu ciency and intraoperative CSF space opening. ConclusionsWe found that ExTS had multiple bene ts compared to MTS for tumor resection in case of CD. These results are in line with our previous publication on the general applicability of an exoscope in pituitary surgery. To our knowledge, this is the rst clinical study proving the superiority of ExTS in CD. These results are promising, nevertheless further studies comparing exoscopic with the endoscopic approach are necessary to nally evaluate the utility of the new technique.

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Value of early postoperative random growth hormone levels and nadir growth hormone levels after oral glucose tolerance testing in acromegaly

Cited by 13 publications

References 24 publications

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

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

First but not second postoperative day growth hormone assessments as early predictive tests for long-term acromegaly persistence

Exoscopic vs. microscopic transsphenoidal surgery for Cushing’s disease: a retrospective single-center study on 388 patients

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