Endocrine Abstracts (2002) 3 P118

Outcome of transphenoidal surgery by one surgeon for acute acromegaly

M Akber, RN Clayton & WV Carlin

Department of Endocrinology, North Staffordshire Hospital, Stoke on Trent, UK.

Objective: Surgical outcome in acute acromegaly has been studied nationally and internationally with conflicting and variable results. Definition of cure varies from centre to centre.Rrecent studies have shown increased mortality in acromegalic patients with GH level >5mu/l. We studied the out come of transphenoidal surgery by a single surgeon at 6 and 12 moths after surgery to compare the results with other national and international published studies.Patients and methods: We analysed the data from the 30 acute acromegalic patients who underwent transphenoidal surgery by one surgeon between 1991 and 2000. 14 (47%) male and 16(53%) female. Age from 21-71 year (mean 45). All these patients were followed at stoke city hospital. Results: 47% achieved the criteria for cure (mean GH < 5mu/l). Cure rate was related to tumour size. In micro adenoma cure rate was 60% in macro adenoma 50% and in macroadenoma with suprasellar / lateral extension cure rate was 0%. Cure rate improved to 80% in micro adenoma after the introduction of endoscopic transphenoidal surgical technique by the same surgeon. We also studied the incidence of hypopituitarism in post surgical cured group. At 12 moths the incidence of hypothyroidism, hypoadrenalism, hypogonadism and diabetes insipidu was, 13, 10, 10 and 7% respectively. Conclusion: Surgical treatment remains first line of treatment in most acromegalic patients. It is safe and effective. Our results are comparable with other studies in macro adenoma, but below national targets in micro adenoma. There was a 100% failure rate in macro adenoma with suprasellar extension. These results stress the need for one trained endocrine surgeon who has more exposure to pituitary surgery in a year to improve the success rate?

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