Single centre audit of surgical outcome in acromegaly
SE Baldeweg1, GS Conway2, M Powell3 & M Vanderpump1
The results of transsphenoidal surgery for acromegaly by a single neurosurgeon (MP) operated between 1981 and July 2002 were examined retrospectively. 141 database and case note records for patients with a clear pre-operative diagnosis of acromegaly were reviewed. Patients with incomplete pre- or postoperative data on growth hormone (GH) status were excluded from further analysis (n=14). The remaining 127 formed the audit group.
Pituitary imaging data was available in 84 of those patients showing microadenomas in 17 (20%) patients and macroadenomas in 68 (80%) patients.
Cure was assessed according to biochemical criteria.
Nadir GH during GTT or random GH <1.5 mU per litre: cure rate was 60 (47%), 11 (65%) and 21 (31%) for overall cure, microadenomas and macroadenomas respectively.
Nadir GH during GTT or random GH <2.5 mU per litre: cure rate was 78 (61%), 12 (71%) and 37 (54%) for overall cure, microadenomas and macroadenomas respectively.
Nadir GH during GTT or random GH <5 mU per litre: cure rate was 96 (76%), 15 (88%) and 47 (69%) for overall cure, microadenomas and macroadenomas respectively.
Surgical cure rate depended on cure criteria and tumor size. Random preoperative GH and cure rate were not significantly correlated.
Our data compares with previous surgical series (surgical remission rates from 21-46%). These findings confirm transsphenoidal surgery to be an effective primary therapy for acromegaly. Cure rate is higher in patients with microadenomas. By most stringent cure criteria, less than half of patients will require adjuvant therapy to achieve a cure.